经椎弓根伤椎撬拨复位植骨治疗胸腰段脊柱骨折

目的:探讨椎弓根伤椎终板撬拨复位器、去螺纹器及椎体内植骨器在治疗胸腰椎段脊柱骨折的应用。方法:自2008年3月至2011年3月收集32例胸腰椎骨折,其中男17例,女15例;年龄25～65岁,平均39.4岁。采用自行设计的经椎弓根终板撬拨复位器、去螺纹器及椎体植骨器行椎体终板复位及椎体内植骨,短节段椎弓根内固定。全部病例要求术前、术后1周、术后1年及内固定取出后3个月行伤椎X线片及CT检查,然后测量伤椎矢状面、额状面后突角度及伤椎高度。结果:32例患者均获得随访,时间14～21个月,平均16个月。随访内容包括后突角度和椎体高度的丢失、骨折愈合情况和内固定植入情况。32例均未出现植骨操作引起的神经、血管并发症,椎体内植骨融合良好。术前、术后1周、术后1年及内固定取出后3个月的统计结果显示伤椎椎体高度保持良好,未出现复位后高度、角度丢失和后期塌陷。结论:采用经椎弓根伤椎终板撬拨复位、去螺纹器及椎体植骨器行椎体终板复位及椎体内植骨治疗胸腰椎骨折能取得满意疗效,而且创伤小,椎体内植骨可促进骨折早期愈合,恢复椎体高度,重建脊柱的稳定性,预防术后晚期椎体高度及角度的丢失,避免了前路手术。     

短节段或单节段内固定结合经椎弓根伤椎植骨对胸腰椎骨折愈合的疗效分析

目的 探讨采用短节段或单节段内固定结合经椎弓根伤椎植骨对胸腰椎骨折愈合的疗效.方法 对34例胸腰椎骨折,应用经伤椎椎弓根椎体内植骨,结合短节段或单节段椎弓根钉棒系统复位固定.结果 术后随访12～26个月,后凸Cobb角由术前的平均20.7°恢复至术后平均3.7°.椎体前缘高度由术前的平均55.3％,恢复至术后平均86.6％.伤椎复位效果好,无明显相邻椎间隙过度撑开.结论 经伤椎椎弓根椎体内植骨,结合椎弓根钉棒系统复位固定治疗胸腰椎骨折,重建了脊柱前中柱的力学结构,获得了稳定性,同时获得有效的椎间盘高度,容纳复位后的髓核,减少伤椎上终板的塌陷,可明显减少内固定断裂、术后Cobb角丢失等并发症.     

经伤椎椎弓根置钉椎体内植骨治疗胸腰椎骨折

[目的]探讨经伤椎椎弓根一侧置钉一侧植骨治疗胸腰椎骨折的临床疗效。[方法]自2007年5月到2010年5月,采用后路椎弓根钉复位内固定结合经伤椎置钉,椎弓根植骨治疗胸腰椎骨折72例,所有患者术前、术后及随访均行X线检查,测量并比较Cobb角、伤椎椎体压缩率。[结果]所有患者随访7～38个月,平均16个月。术后椎体压缩率、Cobb角得到改善。内固定未见松脱断裂,植骨均获得骨性融合。[结论]采用伤椎一侧置钉复位内固定结合一侧经椎弓根植骨治疗胸腰椎爆裂性骨折可有效地防止内固定失败以及脊柱骨折复位丢失和后凸畸形,是治疗胸腰椎爆裂性骨折较理想的方法。     

经伤椎单节段椎弓根钉固定结合球囊扩张自体植骨治疗胸腰椎骨折

目的 探讨经伤椎单节段椎弓根钉固定结合球囊扩张自体植骨治疗胸腰椎骨折的方法及临床疗效.方法 采用体位复位、球囊扩张及椎体内植骨并经伤椎行脊柱内固定治疗胸腰椎骨折17例.结果 随访4～36个月,平均19.2个月,术后Cobb角、椎体高度均恢复满意,骨折均愈合,内固定无松动及断裂.内固定取出后未发现椎体高度丢失及后凸畸形.无手术并发症.结论 经伤椎单节段椎弓根钉固定结合球囊扩张自体植骨治疗胸腰椎骨折,操作安全,疗效满意.     

经伤椎椎弓根植骨在胸腰椎骨折后路钉棒系统内固定中的应用

目的探讨经伤椎椎弓根植骨在胸腰椎骨折后路钉棒系统内固定中的应用价值。方法对32例单节段胸腰椎爆裂骨折采用后路USS内固定结合经伤椎经椎弓根植骨术。结果 31例获得18~24个月的随访,1例失访。随访患者术后椎体高度恢复良好,伤椎高度无明显丢失,未发现内固定物松动或断裂。结论经伤椎椎弓根植骨在胸腰椎骨折后路钉棒系统内固定中应用能有效防止椎体高度二期丢失及内固定物松动或断裂。     

经椎弓根空心椎体植骨器的设计与临床应用

目的 探讨采用经椎弓根空心椎体植骨器行椎体内植骨治疗胸腰椎骨折的价值。方法 采用自行设计的经椎弓根空心椎体植骨器行椎体内植骨配合椎管减压（或不减压），将突人椎管内骨块复位，短节段椎弓根内固定治疗胸腰椎骨折26例。结果 均未出现植骨操作引起的神经、血管并发症，椎体内植骨融合良好。伤椎椎体高度保持良好，未出现复位后高度丢失和晚期塌陷。结论 采用经椎弓根空心椎体植骨器行椎体内植骨操作准确，简单，易掌握，椎体内植骨可促进骨折愈合，重建脊柱的稳定性，预防术后晚期椎体高度的丢失和塌陷。     

后路经伤椎置钉结合经椎弓根植骨治疗胸腰段骨折的效果

目的观察后路经伤椎置钉结合经椎弓根植骨治疗胸腰段骨折的效果。方法对32例胸腰段骨折患者采用后路经伤椎置钉结合经椎弓根植骨治疗,观察治疗后伤椎椎体高度、Cobb角变化及骨折复位情况。结果 32例患者均顺利完成手术,切口甲级愈合,无神经损伤及脑脊液漏。随访12~22个月,平均13.20个月。伤椎高度恢复至正常94.2%,Cobb角较术前均明显改善,随访期间未发生内固定松脱断裂,植骨均获得骨性融合,椎体高度和后凸角无明显再丢失。结论后路经伤椎置钉有助于骨折复位,结合经椎弓根植骨可重建脊柱稳定、促进骨折愈合,是治疗胸腰段骨折的有效方法。     

后路短节段固定结合椎弓根植骨治疗胸腰段骨折

目的 探讨经椎弓根后路短节段复位内固定椎体、后外侧植骨联合、经椎弓根向伤椎椎体内植骨治疗胸腰椎段骨折的手术方法和临床疗效.方法 回顾性分析2007年6月至2011年4月收治的39例胸腰椎骨折患者资料,男21例,女18例;年龄18 ～48岁,平均31.5岁.按照治疗方法的不同分为观察组(经椎弓根后路短节段复位内固定、椎体后外侧植骨联合经椎弓根向伤椎椎体内植骨)和对照组(经椎弓根后路短节段复位内固定椎体、后外侧植骨),通过回顾病历资料及随访资料,对其影像学进行评价.结果 39例患者获12 ～ 36个月(平均20.1个月)随访,观察组与对照组术后即刻伤椎前缘高度恢复程度及成角的矫正程度比较差异无统计学意义(P＞0.05),术后12个月,对照组伤椎前缘高度变化及成角的矫正程度丢失不明显;而未经椎弓根植骨组变化明显,二组比较差异有统计学意义(P＜0.05). 结论 经椎弓根后路短节段复位内固定椎体、后外侧植骨联合经椎弓根向伤椎椎体内植骨治疗胸腰段脊柱骨折有良好的临床疗效,可有效地维持伤椎前缘高度,减少内固定失败率.     

后路椎弓根钉结合椎体成形治疗胸腰椎爆裂骨折

目的:探讨后路椎弓根钉固定结合终板撑开钳复位终板、自固化磷酸钙骨水泥椎体成形治疗胸腰椎爆裂骨折的临床价值。方法:采用后路椎弓根螺钉内固定结合经椎弓根终板撑开钳复位中央终板、自固化磷酸钙骨水泥椎体成形治疗胸腰椎骨折爆裂患者30例(32个椎体),男22例,女8例;年龄25～71岁,平均47岁。骨折节段:T111椎,T125椎,L114椎,L28椎,L32椎,L41椎,L51椎。按Denis分型:A型4椎,B型25椎,C型1椎,D型1椎,E型1椎。通过X线片测量术前、术后及随访8个月时椎体前缘相对高、椎体成角,了解随访期间内固定失败及后凸畸形再发情况;通过CT测量术后椎体内空隙率,通过CT重建片了解术前中央终板骨折塌陷及术后复位情况。结果:所有患者随访8～15个月,平均12个月,伤椎前缘相对高度:术前40.1%,术后98.2%,术后8个月97.8%,术后较术前显著改善,而术后8个月与术后无显著性差异。伤椎椎体成角:术前18.3°,术后2.7°,术后8个月3.2°,术后较术前显著改善,而术后8个月与手术后无显著性差异;未发生内固定失败情况及后凸畸形再发;术后椎体内空隙率3.1%,中央终板骨折塌陷复位满意。结论:后路椎弓根螺钉固定结合自固化磷酸钙骨水泥椎体成形是治疗胸腰椎骨折较理想的方法,能有效防止内固定失败和椎体再发后凸畸形,同时终板撑开钳对中央终板具有良好的复位作用。     

经伤椎短椎弓根钉置钉结合椎体内植骨治疗胸腰椎爆裂性骨折

目的探讨经伤椎短椎弓根置钉结合椎体内植骨治疗胸腰椎骨折的临床疗效。方法自2007年1月到2010年1月．采用后路经伤椎短椎弓根置钉结合椎体内植骨治疗胸腰椎骨折68例,所有患者术前、术后及随访均行X线及CT检查,测量并比较椎管容积率、Cobb角、伤椎楔变角、伤椎前后缘高度比、上下间隙角的变化,同时观察椎体内植骨吸收愈合及神经功能恢复情况。结果所有患者随访15-35个月,平均20．5个月。术后椎体楔变角、上下间隙角、伤椎前后缘高度比均明显改善,内固定未见松脱断裂,植骨均获得骨性愈合＋神经功能较术前有1-2级恢复。术后随访测量以上结果与术后即刻相比仅少许丢失。结论采用经伤椎短椎弓根置钉结合椎体内植骨治疗胸腰椎骨折可有效地防止内固定失败以及脊柱骨折复位丢失和后凸畸形．是治疗胸腰椎骨折较理想的方法。     

Isolated Traumatic Vertebral Pseudoaneurysm: Report of a Case

We report a case of isolated traumatic pseudoaneurysm of the vertebral artery in a 20-year-old man who suffered blunt injury to the left foreneck and arm in a traffic accident. A chest computed tomography (CT) scan on admission showed an upper mediastinal hematoma, but the patient's vital signs were stable. A CT scan of the head and neck showed a cerebral mass, and an elective cerebral four-vessel angiography was performed, whitch revealed a pseudoaneurysm in the proximal portion of the left vertebral artery. At surgery, about 2 cm of the left vertebral artery was found to be lacerated, and suture ligation was done on each side of the laceration. Postoperative intravenous digital subtraction angiography showed an intact right vertebral artery with no residual pseudoaneurysm. There were no neurological complications and the patient was discharged on the 16th postoperative day. Received: December 13, 2001 / Accepted: July 2, 2002 Reprint requests to: T. Saito     

Revisable criteria for vertebral deformity

In order to study vertebral fractures in various study populations, we earlier prepared a database of vertebral dimensions derived from spinal radiographs of 191 normal women seen regularly over 25 years. In this report we have expanded the range of measurements to include vertebral levels T3 to L5. We report means and standard deviations on anterior and posterior heights, on wedge shape and on heights relative to adjacent vertebrae. When one or both of the latter two quantities are far below the mean, a vertebra is called deformed. We also describe a more flexible way of expressing damage using the number of deformed vertebrae, the degree of deformity of individual vertebrae, or the total damage to the entire spine. In assessing damage we use criteria for deformity adjusted to the limits detected by an experienced diagnostician, replacing an earlier approach based on 95% probability limits of normal variation. The normal women from whom these variations are ascertained are a low-prevalence group with respect to vertebral deformity, with prevalence of 2.8%. When the criteria developed from these women were applied to a moderate-prevalence group (37%) the model had a sensitivity of 97%, a specificity of 89% and an accuracy of 92% as regards the identification of subjects with damaged vertebrae. When used epidemiologically for a moderate-prevalence group the model has a known overestimation of 15%. The model is compared with other schemes for identifying vertebral deformities.     

The relative contribution of trabecular and cortical bone to the strength of human lumbar vertebrae

An experiment was performed to determine the relative contribution of the cortical shell and of the central trabecular bone to the peak, non-destructive compressive strength of excised human lumbar vertebrae. The vertebral units tested utilized the adjacent intervertebral discs to distribute the loads. Among other results the study indicated that (1) the cortex generally contributes 45–75% of the peak strength, regardless of percent ash or physical density of the trabecular bone; (2) when the ash content of a vertebral trabecular bone is <59%, only 40% or less of the forces are transmitted directly by the central trabecular bone. When the ash content exceeds 59, >40% of the forces are transmitted via the central trabeculae and, as would be expected, (3) less force is transmitted by way of the central trabeculae in older subjects than in those 40 years of age.From the Department of Radiology, Yale University School of Medicine (S.D.R. and E.S.) and the Department of Engineering and Applied Science, Yale University (J.B.). Supported by USPHS Grants AM-09664 and GM-01152     

Comparison of morphometric assessment of prevalent vertebral deformities in women using different reference data

The semiquantitative assessment of vertebral deformities is based on visual evaluation. The quantitative approach is based on different morphometric criteria. This study is aimed at comparing the impact of different reference groups to define normal vertebral shape on the diagnosis of verterbral deformities. Reference normal values were obtained in three groups of women: French, mixed European, and Argentinian. All these women had normal lumbar spine bone mineral density and no vertebral deformities according to the semiquantitative assessment. In a group of 135 women having vertebral deformities according to Genant’s semiquantitative assessment, three different morphometric criteria were applied. Morphometric diagnosis disclosed a good agreement with semiquantitative assessment. Agreement of diagnosis was higher for a given cutoff using thresholds obtained in different reference groups (κ = 0.84–0.96) and lower when different criteria were compared using thresholds obtained in the same reference group (κ = 0.75–0.85). When fracture thresholds obtained in three different cohorts were compared separately for the three morphometric criteria, agreement was the highest when the cutoff was based only on the arithmetical mean of vertebral heights and was independent of its standard deviation (SD). Average vertebral height ratios did not differ between the three reference cohorts, whereas SDs of vertebral height ratios were the highest in the mixed European cohort and the lowest in the French cohort (F = 7.41, p < 0.001). In the three groups of women of different nationality, SDs of vertebral height ratios, but not the arithmetical means, were significantly higher in the radiographs of poor quality compared with those of good quality. Thus, the main source of difference of diagnosis was related to different SDs whereas average height ratios were not different. Differences in SDs between the three groups were found to be related, at least partly, to poor quality of radiographs. The impact of the differences between populations seems less important, however, only three countries were compared. These findings suggest that those techniques that take into account the SD of vertebral height ratios will provide different reference values for vertebral morphometry. Because differences in SDs depend mainly on the quality of radiographs, they can be reduced by improving the X-ray technique and by the use of standardized protocols. This variability will result in the identification of a variable number of vertebral deformities in osteoporotic women. These results may be of importance especially for multicentric studies.     

Prevalence and severity of vertebral fracture: The saunders county bone quality study

Vertebral fracture prevalence and severity were analyzed by sex and age in an age-stratified proportionate sample of the enumerated population of women and men 50 years of age and older in Saunders County, Nebraska. The sample consisted of 899 women and 529 men. Of these, all but 10 women and 2 men had readable lateral spine radiographs. For both sexes, fracture prevalence rises with age. Women in their fifties have 10% vertebral fracture prevalence, and women in their eighties, 45% prevalence. Men in their fifties have 29% prevalence, and men in their eighties, 39% prevalence. The rise in prevalence and total spinal deformity with age is much greater for women than for men, but the prevalence of vertebral deformity in the fifties is much greater in men than in women.     

颈椎旋转、半失稳与颈性头晕的相关研究

目的:探讨颈性头晕与颈椎旋转、椎体半失稳间的关系。方法:本组86例,按其主诉有无头晕分为无头晕组和颈性头晕组。应用图像存档和传输系统(PACS)测量患者X线正位片上每个颈椎椎体的旋转度和侧位片上椎体间的位移距离。结果:无头晕组C2、C6的旋转度分别比颈性头晕组C2、C6的旋转度小,两组间差异有显著性(P<0.05)。颈性头晕组患者椎体半失稳率为66.7%,椎体间位移距离(0.20±0.18)cm;无头晕组患者椎体半失稳率为44.7%,椎体间位移距离(0.12±0.15)cm。两组患者椎体半失稳率和椎体间位移距离差异均有显著性(P<0.05)。结论:颈性头晕与椎体的半失稳、C2、C6的旋转关系密切。     

Vertebral thoracic osteoclastoma a case report with emphasis on roentgenological findings

Summary A rare case of vertebral osteoclastoma in the body of T₈ is presented. Attention is drawn to its unusual radiological features, not previously reported, and to the relative inefficiency of radiotherapy.The most rational treatment for such a tumour appears to be the widest surgical decompression possible, followed by low-dose irradiation.     

经椎管椎体植骨在胸腰椎骨折中的运用

目的探讨经椎管椎体植骨在胸腰椎骨折中的运用价值.方法用AF系统固定及经椎管椎体植骨治疗胸腰椎骨折23例,并进行随访分析.结果骨折的椎体平均高度(%)术前60.83±15.50,术后95.96±11.16.6个月随访94.80±12.30(P<0.01、P>0.05),内固定物无发生断钉松动等.结论为建立脊柱的稳定,对椎体明显爆裂压缩的患者在手术复位内固定的同时行椎体植骨是必要的,经椎管椎体植骨,是一种较为方便可靠的方法.     

临床论著多节段经椎板间隙椎管扩大术治疗腰椎管狭窄症

目的:探讨多节段经椎板间隙椎管扩大术治疗腰椎管狭窄症的疗效。方法:采用潜式扩大中央椎管和神经根管或摘除椎间盘术式治疗腰椎管狭窄症共86例。其中2节段减压57例,3节段减压19例,4节段减压10例。术后进行Oswestry疗效评分与影像学观察。结果:术后CT显示椎管直径明显增加,椎管造影显示神经根管明显扩大。术后1年随访79例,疗效优良率90.1%;术后3年随访76例,优良率86.3%。结论:多节段经椎板间隙椎管扩大术操作简单,手术并发症少,中央椎管和神经根管减压充分,对腰椎后柱张力带结构破坏小,治疗腰椎管狭窄症疗效满意。