Purpose::Traumatic lumbar hernia (TLH) constitutes a protrusion of content through a defect in the posterior abdominal wall, as a result of injury. This rare entity has been described in limited number of cases.Methods::A systematic review of the literature was performed according to the meta-analysis of observational studies in epidemiology guidelines. The English literature from 1990 until 2021 was reviewed, using PubMed, EMBASE and Google Scholar bibliographic databases, to identify case reports and case series with patients that were diagnosed with TLH. For each eligible study, demographics, clinical presentation, hernia characteristics, preoperative imaging investigations, operation details, and postoperative data were extracted for assessment. Statistical analysis was performed on SPSS, version 20.0.Results::A total of 62 studies were included for review, with 164 patients with TLH. Mean age was (42.6 ± 14.3) years (47.6% males, 31.1% females, gender not specified in 35 cases). Mean diameter of hernia neck was (6.3 ± 3.1) cm, while the triangles of Petit and Grynfeltt were affected in 74.5% and 14.6%, respectively. Patients diagnosed in the emergency setting account for 54.2%, with CT scan establishing diagnosis in all but one case (97.7%). A delayed diagnosis was made in 45.8%, at a mean 1 year following trauma. Flank bulging (82.8%) and chronic back pain (34.3%) were the most frequent symptoms. In both delayed and acute group, open surgery (63.6% and 92.3%, respectively) was the preferred surgical approach. Postoperative complications were reported in 11.4% of acute and 15.0% of delayed patients. Hernia recurrence was 7%.Conclusions::TLH is uncommon with 164 cases described since 1990. CT scan is the gold standard in diagnosis. Open surgery is generally the preferred approach, particularly in the emergency setting. Acute TLH can be treated either by primary suture repair or mesh, depending on the local conditions, whereas delayed cases usually require a mesh.

膈膨升是一种罕见的膈肌病变，其发病率约为0.05%，男性、左侧较为常见[1]。该病变最初由Jean Louis Petit于1774年描述，直到1829年Beclard才在文献中正式使用了"膈膨升"这一术语[2]。膈膨升的病理基础是膈肌的肌纤维或胶原的缺失，导致部分或全部膈肌被纤维弹性组织所取代，使得膈肌的一部分或一侧异常抬高。其解剖学特点是膈肌的连续性保持完整，与胸骨、肋骨和腰背脊柱保持正常连接[3]。膈膨升的症状包括咳嗽、胸痛、心律失常、反复肺部感染等，少数患者可出现胃扭转。膈疝，尤其是Bochdalek疝[4]在影像学上与其具有一些共同特点，是导致临床误诊的重要原因，需要作二维重建CT予以鉴别。由于不同类型的膈肌病变在手术入路和方式上存在一定的差异，误诊可能会导致不适当的治疗策略。因此，如何进行准确的诊断至关重要。我们报道1例以急性胃扭转为主要临床表现的左侧部分膈膨升病例，旨在提高对本病的认识，减少误诊。

Pourfour du Petit综合征(PdPs)也被称为反Horner综合征,是一种罕见疾病,通常由交感神经通路持续受到刺激所致,其特征为瞳孔散大、睑裂开大、眼球突出和多汗症.PdPs可以由于肿瘤、创伤、出血、畸形等因素所导致.现将山西医科大学第二医院神经内科收治的1例丘脑出血引起PdPs患者的临床资料报道如下.

腰疝是指发生在第12肋至髂嵴之间的腹后外侧壁的疝,总体发病率较少,仅占所有腹外疝的1.5％～2.0％.成人腰疝可分为原发性和继发性,继发性腰疝主要是手术和创伤所致,约占所有腰疝的25％;原发性腰疝原因不明,可能与腹内压升高和老龄肌肉萎缩有关,约占所有腰疝的55％[1].原发性腰疝根据部位不同也可分为上腰三角疝(Grynfeltt-Lesshaft疝)和下腰三角疝(Petit疝).既往腰疝治疗的金标准是行腹膜前开放手术[2],应用腹腔镜治疗则是进入腹腔后再实施腹膜外分离[1,3].国内尚无采用泌尿外科常用的后腹腔入路的微创手术治疗腰疝的报道.笔者结合泌尿外科的后腹腔镜手术,同时通过前期的尸体解剖操作练习,熟练掌握后腹腔区域的入路方法和解剖情况,近期成功为2例原发性的上腰疝病人实施后腹腔入路的内镜下全腹膜外补片修补术(retroperitoneal totally endoscopic prosthetic repair,R-TEP),取得良好效果.现报道如下.

This paper presents the present state in diagnosing psychomotor epilepsy in 305 of 847 patients with electroencephalograms in the definiteIy diagnosed group. Average age of onset was 20.1 years. Differences in average age of onset in different series is attributed to the etiology. 56.07% of the cases had psychomotor attacks only, 13.11% had grand mal attacks only, 30.16% had both psychomotor and grand mal attacks, 1 had both psychomotor and petit mal attacks and 1 had both petit mal and myoclonus. Clinical manifestations included loss of consciousness, functional disturbances of the autonomic nervous system, somatomotor disturbances. psychomotor disturbances, special sensory disturbances, affective disturbances, cognitive disturbances and somatosensory disturbances. The relation between EEG and clinical findings is discussed. Improved sphenoidal electrodes were used with better results.

本文收集32例65岁以上无临床帕金森病或其他神经系统变性病变的脑标本，对其黑质、纹状体、蓝斑及海马进行了观察，并以10例靑年人之脑标本为对照，发现老人黑质、蓝斑及海马之神经细胞数目均有减少，并有神经细胞变性，海马部位淀粉样小体增多。这可能为老年人动作徐缓、精力减退、近记忆力差的解剖基础。而纹状体之神经细胞性质、数目与对照组无明显差异。

Since 1972, the authors adopted the percutaneous poking and fixation with a hinged splint for the treatment of 45 cases of fractures of the tibial plateau which had failed at the first attempt of manipulative reduction. According to the principle of integration of "mobilization and immobilization", this type of petit splint not only maintains the reduction, but also allow partial flexion and extension exercise of the knee. This method was relatively simple, less traumatic and less liable to cause infection. Even in the presence of contusions or blisters, the percutaneous operation can still be carried out through a small area of intact skin. The fracture was immobilized with the hinged splint after the principle of 3-point external fixation. The method is most rewarding for the treatment of fractures of the internal or the external tibial plateau.

腰疝是一种少见的发生在腰背侧的腹壁疝,位于第12 肋和髂嵴之间,患病率占所有腹外疝的1.5％～2.0％.腰疝分为先天性( 20％)、原发性(55％)和继发性(25％) [1].原发性腰疝更为常见,可以发生在腰上三角( Grynfeltt )或者腰下三角( Petit).目前,治疗腰疝的手术方式众多,尚无金标准术式,常用的是开放式或者腹腔镜使用人工材料进行腹膜前无张力修补术[2,3] ,腹腔镜手术需要进入腹腔分离腹膜前间隙.在国内,后腹腔入路腹腔镜下完全腹膜后腰疝修补的报道目前仍较少.2021年4～5月我科对2例原发性上腰疝行腹腔镜完全腹膜后修补术,取得良好效果,现报道如下.

目的 探讨超声引导下经Petit三角区腹横肌平面(TAP)阻滞技术联合Lichtenstein无张力疝修补术治疗嵌顿性腹股沟疝的有效性和安全性.方法 回顾性分析2015年1月至2021年1月华中科技大学同济医学院附属武汉市中心医院收治的78例嵌顿性腹股沟疝病人的临床资料,所有病人均为初发嵌顿疝,均在TAP阻滞下松解嵌顿疝环行Lichtenstein无张力疝修补术治疗.结果 78例病人手术均获成功,手术时间为35.2(30～70)min,术后住院时间为3.0(1～7)d.术中发现小肠及系膜嵌顿40例,结肠嵌顿7例,网膜嵌顿24例,腹膜前脂肪嵌顿6例,阑尾嵌顿1例.术后3例病人出现伤口脂肪液化,4例阴囊皮肤淤斑,2例阴囊血清肿,无补片感染及严重并发症病例.术后随访8(1～12)个月,随访率100％,手术侧均无复发,对侧新发腹股沟疝3例,无严重并发症病例.结论 经Petit三角区TAP阻滞技术联合Lichtenstein无张力疝修补术对于嵌顿疝病人尤其合并严重基础疾病者的治疗具有优势,安全性高,并发症少,值得进一步临床推广.