内硬膜

The notable proliferation was not observed by eyes in the local of injection. The infiltration of inflammation cells and mild proliferation of fibrocyte around dura mater was observed by HE stained in 4 and 8 weeks after injection. Infiltration and exudation of inflammation cells was observed by HE stained in epidural nerve root. Compared with group A, no changes of group B, C and D were observed under specific stained. Proliferation of type Ⅱ collagen fibers around dura mater was seen under immunohistochemical stained in 4 and 8 weeks after injection. There is no significant demyelination changes under LFB stained. The thickness and shape of the myelin sheath in epidural nerve root was not regular under transmission electronic microscopy in 4 and 8 weeks after injection. Fibroblast was also seen there. In nerve endometrium, macrophage could be seen under TEM, myelinated nerve fiber changed significantly, but nonmyelinated nerve fiber changed mildly. When 8 weeks, the changes of group D is smaller than the group B and C.

给药局部肉眼观察未见明显的纤维组织增生；HE染色可见B、C、D三组给药后四周及八周时硬膜内外均有炎细胞浸润，纤维细胞轻度增生，硬膜外神经根内有炎细胞浸润及炎性渗出；特殊染色B、C、D三组同A组相比未见有脊髓及神经根的改变；免疫组化染色，给药后四周及八周时，硬膜内外均有Ⅱ型胶原纤维增生；固兰染色B、C、D三组未见有明显脱髓鞘改变，与A组相比无明显异常改变；电镜观察B、C、D三组在给药后的四周及八周时，表现为硬膜外神经根内髓鞘厚薄不一，形状不规则，可见成纤维细胞，神经内膜中可见有巨噬细胞；粗大的有髓神经纤维变化明显，无髓神经纤维受累较轻；八周时电镜下D组改变较B、C两组为轻。

objective to investigate the paregoric effects of butorphanol when the errhysis occurs inside the epidural catheter during continuous epidural anesthesia.methods 60 cases of kidney stones received elective surgery.during this surgery they underwent continuous epidural anesthesia and eight cases of them showed the errhysis in the epidural catheter.then epidural injection of butorphanol was given for analgesia and hr,map,spo2 as well as muscle relaxation conditions were monitored before and 5,10,20 min after injection.the conscious and breathing of patients were also monitored.results before and 5,10,20 min after injection of butorphanol,hr and map difference were not statistically significant.the analgesic results were satisfactory.conclusion butorphanol has a definite analgesic effect when the errhysis occurs in epidural catheter during continuous epidural anesthesia.

目的 探讨在连续硬膜外麻醉中，硬膜外导管内渗血时，应用布托啡诺镇痛的效果。方法择期行肾结石手术患者60例，行连续硬膜外麻醉，其中8例硬膜外导管内渗血，均经硬膜外腔注入布托啡诺镇痛，分别监测注入前及注入后5 、10 、20 min，hr、map、spo2及肌肉松驰情况，同时监测患者神志及呼吸情况。结果注射布托啡诺前及注射后5、10、20 min，hr、map差异无统计学意义，镇痛效果满意。结论在连续硬膜外麻醉中硬膜外导管渗血时，注入布托啡诺维持麻醉镇痛效果明确。

Results: Lateral extradural approach could be used to expose the second and third branches of trigeminal nerve,trigeminal ganglion,posterior vertical segment of the intrapetrosal ICA,abducent nerve and horizontal segment of the intrapetrosal ICA;lateral intradural approach could be used to expose the lateral,anteroinferior and posterosuperior venous spaces,almost all the cranial nerves within the cavernous sinus and horizontal segments of the intracavernous ICA;superior approach could be used to expose the medial,lateral and posterosuperior venous spaces,medial side of the anterior genu,anterior vertical and clinoidal segments of the intracavernous ICA and the lateral side of the hypophysis.

结果：外侧硬膜外入路可用于显露三叉神经第2、3支，三叉神经节，海绵窦内颈内动脉后垂直段，外展神经及岩骨颈内动脉水平段；侧方硬膜下入路可用于显露海绵窦外侧及前下，后上静脉间隙，以及所有走行在海绵窦内的颅神经和海绵窦内颈内动脉水平段；上方入路可用于显露海绵窦内侧、外侧及后上间隙，海绵窦内ICA水平段、前膝、前垂直段及床突段的内侧面，以及垂体的外侧面。

During a long-term follow-up study, 6(21%) patients died and 8(29%) patients suffered recurrence of their tumors in intradural group, while 1 patient died and 3 patients suffered recurrence of their tumors in the early epidural group.

硬膜外入路应用早期(1985～1992)，肿瘤全切率71%(27/38)，近全切29例，晚期分别为91%(29/32)和3例，长期随访中，硬膜内入路组6例死亡，8例复发，早期硬膜外入路组1例死亡，3例复发。

Methods A microanatomical study was conducted in 50 sides specimens for designing and using middle fossa epidural approach.A retrospective contract review of 98 patients with TN treated via intradural or epidural approach (1978～1997)was undertaken.

在50侧尸体头标本上进行中颅底显微解剖研究，设计硬膜外手术方案，并对我科经硬膜内入路和硬膜外入路治疗的98例(1978～1997)三叉神经瘤病例进行回顾性对比分析。

Then the muscle pack was placed intradural, and the gelfoam soaked with ZT mucilage was tamponed intra-and extra-dural to support the packing.

结果显微镜下凿开鞍底充分暴露硬膜漏口，向硬膜漏口内填塞肌肉块，无脑脊液流出后，用渍ZT胶的明胶海绵填塞于硬膜漏口的内、外侧和蝶窦腔。

It was achieved by intradural microanastomosis of the L6 ventral root to S2 ventral root. After axonal regeneration, the "patellar ligament-spinal cord center-bladder" reflex pathway was reestablished. The function of the reflex arc was observed by nerve electrophysiological experiment, detrusor electromyography experiment, urodynamic testing and HRP retrograde tracing before and in 8 months after the spinal cord was destroyed horizontally between S1 and S4 level. There was one case of conical SCI patient who had L1 fracture and paraplegia was received intradural microanastomosis of the L6 ventral root to S2 ventral root after Li fracture and paraplegia.

将Beagle犬L6前根近端与S2前根远端在硬膜内显微吻合，经一段时间的轴突再生后，建立&膝腱－脊髓中枢－膀胱&人工反射弧，术后8个月，在破坏S1~S4脊髓节段前后分别进行神经电生理、膀胱肌电图及尿流动力学和辣根过氧化物酶逆行示踪等检查；对1例L1压缩性骨折伴截瘫患者行右侧T11与52前根经腓肠神经移植硬膜内吻合术。

Methods :25 cases of traumatic hydrocephalus were analysed retrospectively.Among them,3 cases showed brain contusion,4 with subrarchnoid hemorrhage,5 with subdural effusion,2 with epidural hematoma,1 with subdural hematoma,1 with fracture of skull,3 with malacia lesions,3 with cerebral infarction,and 2 with cerebral hernia.The other 3 cases were not associated,with intracranial traumatic anomaly.

回顾分析25例外伤性脑积水，其中分别伴颅脑损伤有3例脑挫伤、4例蛛网膜下腔出血、5例硬膜下积液、1例颅骨骨折、3例脑内软化灶、3例脑梗塞、2例硬膜外血肿、1例硬膜下血肿、2例脑疝(大脑镰下疝及钩回疝各1例)，另3例颅内未见外伤性异常改变与其并存。

Results: The male patients appeared more than females in spinal cord AVMs, but the occult intramedullary AVMs had the same morbidity The patients with intramedullary AVMs and perimdeullary AVF were younger, in contrast, patients with dural AVF were usually older than 40 years of age. The intra - medullary AVMs were most common located in the cervical and thracic - lumbar spinal cord, the perimedullary AVF and dural AVF were most seen in the low thracic of lumbar region. The most common initial symptom associated with intramedullary lesions was accute onset where as the progressive aggravation was the most common presenting symptom in cases of dural AVF. The prognosis of the patients with intramedullary lesions had hemorrhage was worse than who without hemorrhage.

结果：脊髓AVM s中，隐匿型AVMs无明显的性别差异，余各类型男性均多于女性；髓内AVMs、髓周AVF以青少年多见，硬膜型AVF发生于中老年；髓内AVMs多见于颈髓及胸腰段脊髓，髓周AVF及硬膜型AVF多见于胸腰段；髓内AVMs以急性起病多见，髓周AVF表现为进行性加重，少数可急性发作，硬膜型AVF以慢性起病多见；髓内出血者预后较无出血者差。

Results 5 cases of ependymocytoma, 3 cases of astrocytoma, 1 medulloblastoma hemangioblastoma in 10 cases of intra-medullary tumor; 36 cases of neurogenic tumor, 11 cases of spinal meningioma in 47 cases of subdural extramedullary tumor; 2 cases of neurogenic tumor strided over scleromeninx;2 cases of extradural metastatic tumor, 1 cestodiasis, 2 cases of epidural hematoma, which were mistaken for hemangioma before surgical operation and 1 vascular malformation in 4 cases of intraspinal nontumorous occupying lesion.

结果：10例髓内肿瘤中，室管膜瘤5例；星形细胞瘤3例；血管母细胞瘤1例；成神经管细胞瘤1例。47例脊髓外硬膜下肿瘤中，神经源性肿瘤36例；脊膜瘤11例。2例跨硬膜内外生长的神经源性肿瘤2例。硬膜外的转移瘤2例。4例椎管内非肿瘤性占位性病变中，椎管内绦虫病1例；硬膜外血肿2例，术前误为血管瘤；血管畸形1例。

We have no common name for a mime of Sophron or Xenarchus and a Socratic Conversation; and we should still be without one even if the imitation in the two instances were in trimeters or elegiacs or some other kind of verse--though it is the way with people to tack on 'poet' to the name of a metre, and talk of elegiac-poets and epic-poets, thinking that they call them poets not by reason of the imitative nature of their work, but indiscriminately by reason of the metre they write in.

索夫农 、森那库斯和苏格拉底式的对话采用的模仿没有一个公共的名称；三音步诗、挽歌体或其他类型的诗的模仿也没有——人们把&诗人&这一名词和格律名称结合到一起，称之为挽歌体诗人或者史诗诗人，他们被称为诗人，似乎只是因为遵守格律写作，而非他们作品的模仿本质。

The relationship between communicative competence and grammar teaching should be that of the ends and the means.

交际能力和语法的关系应该是目标与途径的关系。