材料:电脑一台、可拍照手机一部、透明胶布、剪刀1.电脑屏幕变“阅片灯”打开电脑,新建一个PPT文档(幻灯片),点击幻灯,在电脑右下角处点击全屏播放按钮,这时电脑屏幕摇身一变成为阅片灯。2.如何确定片子的正反顺序?在“电脑屏幕”上放X光或CT片(确保片子上的文字是顺的,就说明片子方向是正确的),用胶布在电脑屏幕固定,片子就很会清晰地显示了!备注:确保片子上的文字是顺的,拍摄时也确保文字可以阅读,这样的图片质量大多数可用于诊断。3.关闭手机闪光灯用手机的相机拍照时要关闭“闪光灯”,建议每次以“四小格”的形式拍照,保证图像的清晰度。然后按顺序发送即可。
摘要:目的探讨经病灶肿瘤刮除、分块切除术治疗颈椎骨巨细胞瘤的安全性及治疗效果。方法回顾性分析2006年4月至2015年7月我院收治的6例采用经病灶手术切除治疗颈椎骨巨细胞瘤患者的资料,男2例,女4例;1例行病灶刮除手术,2例行病灶扩大刮除术;ⅢB期3例,1例行扩大刮除术,2例行椎体次全切除术。3例术中行病灶边缘灭活。1例C2骨巨细胞瘤在肿瘤切除术前接受局部放射治疗,3个月后再次行后路及前路肿瘤切除、植骨内固定术;1例C2骨巨细胞瘤在肿瘤刮除术前予地诺单抗辅助治疗;3例术后接受双膦酸盐治疗。采用Frankel脊髓损伤分级评价手术前后患者的神经功能,视觉模拟评分(visual analogue scale,VAS)评价手术前后患者疼痛程度,影像学检查评价术前肿瘤的位置和范围,以及术后肿瘤是否复发。结果 本组6例均获得随访,随访时间25~134个月,平均61.1个月。1例行单纯后路手术,5例行前路手术+后路手术;3例患者行一期手术,3例患者行分期手术,其中2例行2次手术,另1例行4次手术;术中总出血量300~9 100 ml,平均2 142 ml。6例术前VAS评分为2~5分,平均3分,Frankel分级为E级,术后所有患者颈部疼痛均缓解,VAS评分均为0分,术后Frankel分级均为E级。1例术后第2天出现颅内硬膜外血肿,急诊行血肿清除术,术后恢复良好。至末次随访,所有患者均未出现内固定松动及失败,均未发现肿瘤复发。结论颈椎骨巨细胞瘤经病灶刮除、分块切除手术是一个安全、有效的手术方式,可以获得满意的肿瘤局部控制以及预后。Abstract:Objective To investigate the safety and efficacy of curettage and excision for giant cell tumor of the cervical spine.Methods Retrospectively analyzed 6 cases of giant cell tumors patients who underwent surgical resection of cervical spine between April 2006 and July 2015.There were 2 males and 4 females with an average age of 31.3 years old (ranged from 18 to 42 years).Among them,4 cases were located in C2 vertebral body,1 case located in C3 vertebral body,1 case in C4 spinous pro cess and vertebral lamina.In this study,all the 6 patients underwent intralesional surgery,3 patients were Enneking grade ⅡA,which 1 case underwent curettage,2 cases underwent extended curettage;three cases were Enneking grade ⅢB,which 1 case underwent extended curettage,and 2 cases underwent subtotal spondylectomy.Three patients received local inactivation of the lesion.One patient received local radiotherapy after first posterior occipital-cervical fixation,and underwent posterior and anterior tumor resection,bone grafting and internal fixation 3 months later.One patient was treated with denosumab preoperatively,3 patients were treated with bisphosphonates postoperatively.The neurological status was evaluated by Frankel classification pre-and postoperatively,the pain scale was evaluated by Visual Analogue Scale (VAS) pre-and postoperatively.Imaging examination was used to assess the location and the extent of the tumor preoperatively,as well as the tumor recurrence postoperatively.Results The mean follow-up period was 61.1 months (ranged from 25 to 134 months).One case underwent posterior surgery,while other 5 cases underwent anterior and posterior surgery;3 patients underwent one-stage surgery,3 patients underwent multi-staged surgery.The mean intraoperative bleeding was 2 142 ml (ranged from 300 to 9100 ml).The mean preoperative VAS score was 3 (ranged from 2 to 5),the neck pain of the patients were all relieved postoperatively,and the mean VAS score was 0.The Frankel grade were E in all 6 patients of pre-and postoperation.One intracranial epidural hematoma occurred on the second day after operation,emergency evacuation of hematoma was then performed and the postoperative recovery was good.At the latest follow-up,no internal fixation loosening or failure occurred,and no tumor recurrence was observed in all patients.Conclusion Intralesional curettage and excision of the cervical spinal giant cell tumor is a safe and effective surgical method which can achieve satisfactory local control and prognosis.
摘要:目的:探讨骨质疏松性椎体压缩性骨折行经皮椎体成形术(percutaneous vertebroplasty,PVP)时穿刺失误所致并发症的治疗方法。方法:回顾性分析2011年12月至2014年11月收治3位骨质疏松性椎体压缩性骨折PVP术后出现并发症行翻修手术患者的病历资料,均为女性,年龄71~82岁,平均78岁。1例患者因“骨质疏松性T12椎体压缩性骨折”,PVP术后出现椎管内骨水泥外漏致左侧腹部束带感、左腹股沟区痛触觉减退,1年后行“前路减压、骨水泥取出及内固定术”。1例患者因“骨质疏松性L1椎体压缩性骨折”,PVP术后出现椎管内骨水泥外漏致腹部及双下肢疼痛、双下肢肌力下降以及痛、触觉减退,再次行“后路减压、骨水泥取出及内固定术”。1例患者因“骨质疏松性T12椎体压缩性骨折”,PVP术后出现椎管内血肿致两下肢肌力0级,感觉障碍,再次行“后路椎板减压、椎管内止血及血肿清除术”。再次术后随访21~29个月,平均24.7个月,观察患者恢复情况,并分析出现并发症的原因。结果:1例患者翻修术后腹部束带感消除,左侧腹股沟区痛、触觉改善,随访21个月内固定无松动;1例患者术后腹部及双下肢疼痛缓解,双下肢肌力恢复至4级,双下肢痛触觉恢复正常,随访29个月内固定无松动;1例患者术后双下肢肌力、感觉略恢复,同时残留双下肢疼痛,一直未完全缓解,患者在术后2年死亡。结论:骨质疏松性椎体压缩性骨折行PVP术后出现脊髓受压的并发症,虽然翻修手术难度大,风险高,但只要通过合适的手术方式进行翻修可以获得良好的治疗效果。Abstract:Objective To investigate the treatment of the complications of puncture lapsus after the percutaneous vertebroplasty (PVP) for osteoporotic fractures.Methods From December 2011 to November 2014,3 female patients with postoperative complications of PVP which were treated for osteoporotic fractures,aged from 71 to 82 years (average,78 years old) were involved.Each of them performed a revision surgery in our hospital.One of them was performed with PVP of the 12th thoracic vertebral due to the osteoporotic thoracic vertebral compression fracture.However,bone cement was leaked into spinal canal after PVP,and the patient suffered from left abdominal constriction and impaired of sensation in left inguinal region.She underwent anterior approach of decompression,cement removal and internal fixation one year after the first operation.The second case was performed with PVP of the 1st lumbar vertebral due to the osteoporotic lumbar vertebral compression fracture.In this case,bone cement was leaked into spinal canal after PVP,and the patient suffered from abdominal and lower extremity pain,paralysis,and hypoesthesia of lower limbs.This patient was treated with posterior approach of decompression,cement removal and internal fixation.The third case was performed with the 12th thoracic vertebral PVP due to the osteoporotic thoracic vertebral compression fracture.Subdural hemorrhage happened after PVP,and the patient suffered from paralysis and sensory loss of the two lower limbs.This patient was treated with posterior approach of laminotomy,hemostasis in the spinal canal and evacuation of hematoma.We performed a follow up from 21 to 29 months (average,24.7 months),to observe the recovery of the patients.Results one case' s abdominal constriction eliminated and the inguinal region pain improved after the revision surgery,and there's no internal fixation loosening with the follow-up of 21 months.The other case's abdominal and lower limb pain relieved,the lower limb muscle strength recovered to grade 4,and the tactile of lower limb recovered to normal after the revision surgery.There' s no internal fixation loosening with the follow-up of 29 months.One case of patients with slightly recovered of lower extremity muscle strength and feeling after surgery,and remained lower limb pain,died two years after the surgery.Conclusion Complications of spinal cord compression after percutaneous vertebroplasty (PVP) for osteoporotic fractures can get good outcomes by using appropriate revision surgeries,although revision surgery is difficult and risky.
摘要:目的探索肿瘤特异性免疫细胞杀伤骨肉瘤的实现方法,并分析使用过继性细胞输注免疫治疗对骨肉瘤产生的治疗效果。方法使用地西他滨(Decitabine,DAC)作为去甲基化药物对HOS及U20S骨肉瘤细胞系进行治疗,采用PCR及Western Blot检测治疗后肿瘤-睾丸抗原(cancer-testis antigen,CTA)的表达情况。在动物实验中,使用转染了萤火虫荧光素酶和HLA-A0201的人源肿瘤细胞系HOS在免疫缺陷NOD-SCID小鼠上成瘤,并使用DiR染色标记体外培养扩增的CTA特异性对应HLA人源CD8+T细胞输注,通过小动物活体成像系统检测T细胞在小鼠体内的分布,同时监测治疗过程中小鼠瘤块的生长情况。使用鼠源骨肉瘤细胞系K7M2在免疫健全鼠BALB/c成瘤,进行去甲基化,使用流式细胞仪分析治疗前后肿瘤块内淋巴细胞的比例、数量以及CD8+T细胞的活化情况,判断去甲基化对自体淋巴细胞浸润、活化的作用。结果使用DAC对骨肉瘤细胞系HOS及U20S进行去甲基化后,所有被检测的CTA表达均不同程度的提高。在体外培养的骨肉瘤细胞经过至少5d的DAC治疗后能被CTA特异性CD8+T细胞显著杀伤,DAC本身对骨肉瘤细胞系生长可产生抑制作用。在免疫缺陷动物模型中,经过DAC去甲基化预治疗的荷瘤小鼠能观测到明显的CTA特异性T细胞向肿瘤组织归巢现象,同时,去甲基化预治疗联合CTA特异性T细胞输注治疗显著抑制了骨肉瘤移植瘤的生长。在免疫健全鼠肿瘤模型中,去甲基化能促进自体T细胞向肿瘤组织的归巢,并提高肿瘤内CD8+T细胞的活性及其分泌的干扰素γ、颗粒酶B、穿孔素水平。结论去甲基化能在抑制骨肉瘤细胞生长的同时,提高骨肉瘤细胞的CTA表达,为以CTA为靶点的特异性细胞免疫输注治疗提供条件。Abstract:Objective To investigate feasible immunotherapy strategy using tumor specific cell against osteosarcoma,and to analyze the therapeutic effect of adoptive cellular infusion therapy on osteosarcoma.Methods Decitabine (DAC) was employed as a hypomethylating agent for the treatment in osteosarcoma cell lines HOS and U2OS.After treatment,the expression of cancer-testis antigen (CTA) was evaluated by PCR and Western Blot.In animal studies,human osteosarcoma cell line HOS,which was transfected by luciferase and HLA-A0201 in previous,was inoculated into immune deficient NOD-SCID mice to establish osteosarcoma xenografts.Ex-vivo expanded CTA specific homo CD8+T-ells were labeled with DiR and injected into the mice via the tail vein.In vivo imaging system was utilized to detect the distribution of administrated CD8+ T-cells.In addition,the progression of tumor xenografts was monitored.Moreover,mouse K7M2 osteosarcoma cell line was used to establish animal models in immune competent BALB/c mice.Immune competent models were utilized to evaluate the effectiveness of hypomethylating treatment in regarding to spontaneous immune attack against tumors.Flow cytometry was used to analyze the proportion of intratumoral lymphocytes and the status of these effector antitumor immune cells,and to reveal the effect of hypomethylating treatment in facilitating lymphocyte infiltration and activation.Results The expression of all the evaluated cancer/testis antigens were elevated in HOS and U2OS osteosarcoma cell lines after hypomethylating treatment with DAC.The proliferation of in vitro cultured osteosarcoma cells can be significantly suppressed after at least 5 d treatment with DAC.Besides,DAC alone controlled osteosarcoma cell proliferation.In immune deficient mouse models,hypomethylating pre-treatment resulted in successful T-cell homing to tumor sites.Moreover,the combination treatment with DAC and CTA specific T-cell adoptive transfer significantly suppressed tumor proliferation.In immune competent mouse models,hypomethylating treatment with DAC improved autologous T-cell infiltration into the tumor,and strengthened the activity of intratumoral CD8+ T-cells,elevated the secretion of IFN-gamma,granzyme B and perforin by CD8+ T-cells.Conclusion Hypomethylating treatment is able to suppress osteosarcoma cell proliferation,improve the expression of CTA in osteosarcoma cells,and consequently provide optimal environment for CTA specific T-cell adoptive therapy.
【摘要】 目的:探讨脊柱骨母细胞瘤的临床特点、诊断、治疗方法和手术疗效。方法:回顾性分析2007年5月至2016年5月收治的11例脊柱骨母细胞瘤患者的临床表现、影像学资料、治疗方法以及预后。男7例,女4例;年龄15~44岁,平均27.5岁。病变位于颈椎2例、胸椎6例、腰椎3例。所有患者均存在局部疼痛病史。4例伴有神经症状,其中3例伴有不同程度的神经根症状,1例伴有脊髓受压症状(Frankel c级)。4例患者为Enneking 2级,均行病灶内刮除或切除术;7例患者为Enneking 3级,4例行单一后路病灶扩大切除术,1例行颈椎前后联合入路病灶扩大切除术,2例行单一后路全脊椎分块切除术。术后通过定期随访评估患者疼痛缓解情况,神经功能恢复情况和肿瘤的复发情况。结果:手术时问为1.5-7 h,平均3.5 h。术中出血量为100~3 000 ml,平均800 ml。1例围手术期出现脑脊液漏,2例出现胸腔积液,所有病例均未出现切口感染。术后所有患者疼痛得到明显缓解。术后3例患者神经根症状完全缓解,l例脊髓压迫症状改善(Frankel E级)。术后随访12~117个月,平均45.8个月,其中1例C7T1肿瘤患者术后4年复发。予以再次人院行肿瘤扩大切除术,并更换内固定,末次随访未见肿瘤复发。其余患者未见肿瘤复发。所有患者均未见植入物松动或断裂。结论:Enneking 2级的脊柱骨母细胞瘤,病灶内刮除手术可以取得良好的治疗效果;对于Enneking 3级则首选肿瘤扩大切除或全脊椎分块切除术。无论手术是否经病灶切除,只要切除彻底,均可以获得满意的效果。【关键词】脊椎肿瘤,成骨细胞瘤,外科手术【证据等级】治疗性研究Ⅳ级