脊柱畸形老年人躯干质心偏移的相关因素分析

目的 了解脊柱畸形患者躯干质心偏移的影响因素.方法 应用Spinalmouse测量脊柱的椎间夹角、脊柱倾角(躯干前倾角度),并分析脊柱倾角与性别、年龄、胸椎总体曲度、腰椎总体曲度的相关性.结果 年龄与躯干倾斜正相关,相关系数为0.448(P<0.01).胸椎总体曲度与躯干倾斜显著正相关,相关系数0.196(P<0.01).腰椎总体曲度与躯干倾斜显著正相关,相关系数0.56(P<0.01).胸椎与腰椎曲度呈显著负相关,相关系数-0.233(P<0.01).除了中位胸椎外,躯干倾斜角度与多数立位椎间夹角呈现显著相关关系;其中上位胸椎夹角间存在负相关关系,下位胸椎及腰椎则存在正相关关系.结论 随着年龄的增大,脊柱倾斜逐渐增加,胸椎、腰椎后凸越严重,脊柱前倾越明显.上位或下位胸椎越后凸,腰椎越变直,则躯干倾斜角越大.胸椎后凸曲度增加,一般伴随腰椎前凸曲度的增加,这有可能增加局部椎体压缩骨折风险.     

关节镜辅助下经椎弓根椎体截骨矫正胸腰段脊柱后凸畸形

目的研究关节镜辅助下经椎弓根椎体截骨矫正胸腰段脊柱后凸畸形的临床疗效。方法选择21例骨折后陈旧性胸腰段椎体后凸畸形患者,所有患者均采用后路关节镜辅助下经椎弓根椎体截骨技术于后凸顶椎处进行椎体截骨,通过椎弓根固定系统加压固定。观察手术前后后凸畸形的矫正率、疼痛VAS评分及神经功能的恢复。结果所有患者均获得随访,术后后凸角平均为9°,平均矫正约27．8°;腰背部疼痛均有明显缓解;神经功能明显恢复。结论关节镜辅助下经椎弓根椎体截骨术矫正胸腰段脊柱后凸畸形是一种安全有效的方法。     

胸腰段后凸畸形对腰椎稳定性影响的生物力学实验研究

24例成年家猪胸腰椎脊柱新鲜标本,随机分为3组,建立两个Cobb角度水平的胸腰段后凸畸形和相应的腰椎过度前凸模型,进行脊柱三维运动实验,测量L2～L3和L4～Ls的前屈/后伸、左/右侧屈、左/右旋转的运动范围(ROM)以及所对应的中性区(NZ)的大小.对各组数值进行方差分析,用snk(q检验)法对分组变量进行多重比较.结果:后凸的胸腰段对邻近运动节段(L2～L3)矢状面上的运动(前屈/后伸)ROM以及NZ的影响更明显,P＜0.05.认为腰椎前屈/后伸运动范围的过度增大,是胸腰段后凸畸形后为维持脊柱矢状面平衡的一个重要代偿改变,且ROM的增大以上腰椎的改变更为明显,而对下腰椎的影响不大.     

AF椎弓根螺钉内固定系统用于胸腰段脊柱骨折39例疗效观察

目的探讨AF椎弓根螺钉内固定系统（简称AF系统）用于胸腰段脊柱骨折的疗效及机制。方法对39例胸腰段脊柱骨折患者采用AF系统行复位固定术,观察畸形纠正情况、神经功能恢复情况和并发症发生情况。结果术后椎体前后凸高度均明显增加,椎体后倾Cobb’s角明显减小,侧凸角度明显减小,神经功能Frankel分级均明显降低,P均〈0．01。未出现明显并发症。结论AF系统用于胸腰段脊柱骨折效果确切,手术切口短,操作简单,椎体复位效果好,固定牢固,可减少椎管减压及植骨。     

老年人脊柱畸形与骨密度的关系

目的 探讨骨密度与脊柱畸形之间的相关关系.方法 应用双能X线仪及Spinalmouse测量腰椎骨密度、股骨颈的骨密度及脊柱椎间夹角,对骨密度与脊柱畸形相关的数据进行相关分析.结果 股骨颈骨密度与脊柱各节段之间的夹角均不存在明确的相关关系,而腰椎的骨密度则与胸(T)7/8间隙负相关,而与腰(L)1/2、L5骶(S)1正相关.腰椎骨密度与胸椎立位整体曲度存在明显负相关,股骨颈骨密度则不存在这种相关关系.男性骨密度明显高于女性骨密度.随年龄增长,股骨颈的骨密度与年龄之间存在负相关关系,而腰椎骨密度则未发现明显的负相关.结论 T7/8及L1/2椎间夹角能够反映腰椎骨密度高低.60岁之后,性别对骨密度的敏感度较年龄要高,年龄对股骨颈骨密度的敏感度比腰椎骨密度高.     

经皮椎体成形术治疗骨质疏松性压缩性骨折的有限元力学分析

目的建立胸腰段骨质疏松性椎体压缩性骨折的病理三维有限元模型,分析手术前后病椎及邻近椎体应力变化情况。方法取CT三维重建资料通过软件MIMICS10.0建立椎体的三维实体模型,以三维有限元分析软件ANSYS12.0模拟经皮椎体成形术(PVP)过程在腰1(L1)椎体中置入不同容量骨水泥(2、4、6、8 ml),分析轴向压缩直立、前屈、后伸、侧弯、旋转5种加载状态下手术前后相邻椎体的应力变化。结果小剂量骨水泥注入(2、4 ml),病椎所受应力逐渐增加,而较大治疗量骨水泥注射入(6、8 ml),随着病椎硬度及刚度加强,其所受应力逐渐下降;而临近椎体在骨水泥注入量逐渐增加过程中,所受应力未见明显改变。结论对于老年骨质疏松性压缩性骨折的力学研究,三维有限元力学分析具有良好的应用前景及临床价值;在能够避免大治疗剂量骨水泥注入所带来并发症(如渗漏)前提下,4⁸ ml骨水泥注入量更加有效,且不增加邻近椎体骨折的风险。     

伤椎置钉GSS系统与传统手术治疗胸腰段脊柱骨折的临床效果比较

目的探讨伤椎置钉GSS系统在胸腰段脊柱骨折患者治疗中的临床应用效果。方法选取该院2010-03~2016-03收治的胸腰段脊柱骨折患者200例,按随机数字表法分为对照组和观察组各100例,对照组采用传统手术进行治疗,观察组采用伤椎置钉GSS系统进行治疗。术后第2周比较两组临床疗效。结果观察组治疗后椎体后缘高度、椎体前缘高度、Cobb角均优于对照组(P0.01);观察组治疗有效率高于对照组,差异均有统计学意义(P0.01)。结论伤椎置钉GSS系统在治疗胸腰段脊柱骨折中可使患者临床症状得到明显改善,可显著提高临床疗效,具有推广应用价值。     

部分椎弓根椎体内截骨矫形术对胸腰段陈旧性骨折患者椎间孔内径的影响

目的观察部分椎弓根椎体内截骨矫形术对胸腰段陈旧性骨折患者椎间孔内径的影响。方法采用部分椎弓根椎体内截骨矫形术治疗胸腰段陈旧性骨折20例,术前及术后7d均行CT检查,测量脊柱旁矢状位重建后椎间孔上下径、上前后径、下前后径及椎间孔面积。结果术前椎间孔上下径为（23．80±2．27）mm,上前后径为（11．63±1．61）mm,下前后径为（11．67±1．35）mm,横截面积为（63．15±4．34）mm^2;术后分别为（22．50±1．76）、（12．95±1．34）、（11．84±1．12）mm及（57．43±3．54）mm^2。手术前后上下径、上前后径比较,P均〈0．05。结论部分椎弓根椎体内截骨矫形术治疗胸腰段陈旧性骨折,可使患者椎间孔上下径缩小、上前后径扩大。     

后路减压内固定治疗胸腰段椎体骨折27例效果观察

胸腰段椎体是脊柱外伤骨折的多发部位,骨折常合并不同程度的脊髓损伤,椎体骨折表现为压缩变形、高度丢失、后凸畸形。2005～2008年,我们对27例胸腰段椎体骨折患者行后路减压内固定术治疗,效果满意。现报告如下。     

经后路伤椎椎弓根钉固定胸腰椎爆裂骨折的稳定性

目的研究经后路伤椎椎弓钉固定胸腰椎爆裂骨折的稳定性。方法选取9份小牛胸腰椎(T11~L3)段标本,根据经后路伤椎椎弓钉固定方式分为三组:跨骨折椎体固定组、单侧伤椎固定组、三椎体固定组,每组3份标本,检测各组标本正常、骨折和固定状态下的各项指标:应用生物材料试验机检测轴向刚度,应用三维激光扫描仪检测椎间活动度(前屈、后伸、左轴向旋转、右轴向旋转、左侧弯、右侧弯),并测试在固定状态下不同扭矩的扭转角度,评价经后路伤椎椎弓钉固定胸腰椎爆裂骨折的稳定性。结果固定状态下单侧伤椎固定组、三椎体固定组的轴向刚度较跨骨折椎体固定组明显增加(P<0.05),而单侧伤椎固定组、三椎体固定组的轴向刚度比较差异无统计学意义(P>0.05);固定状态下三组的轴向刚度明显高于骨折状态(P<0.05)。正常状态和骨折状态下,三组的椎体椎间活动度(前屈、后伸、右侧弯、左侧弯、右轴向旋转、左轴向旋转)比较差异无统计学意义(P>0.05),固定状态下单侧伤椎固定组、三椎体固定组的椎体椎间活动度(前屈、后伸、右侧弯、左侧弯、右轴向旋转、左轴向旋转)较跨骨折椎体固定组降低(P<0.05),而单侧伤椎固定组、三椎体固定组的椎体椎间活动度比较差异无统计学意义(P>0.05)。在5 Nm、10 Nm的扭矩下,单侧伤椎固定组、三椎体固定组的扭转角度小于跨骨折椎体固定组(P<0.05),而单侧伤椎固定组、三椎体固定组的扭转角度比较差异无统计学意义(P>0.05)。结论经后路伤椎椎弓钉固定术能明显改善胸腰椎爆裂骨折的轴向刚度和椎体椎间活动度,减少扭转角度,从而提高伤椎的稳定性。     

Lumbar lordosis in acute and chronic low back pain patients

Postural changes are sometimes a risk factor for low back pain. Abnormal posture creates a strain on ligaments and muscles that indirectly affects the curvature of the lumbar spine. This study was planned to investigate the relationship between the angles of the lower lumbar spine and spinal mobility in acute and chronic low back pain patients. Fifty patients (25 female, 25 male) with chronic low back pain and fifty (30 female, 20 male) with acute low back pain were included the study. Both groups were subjected to lumbosacral radiography in the lateral position while standing. Patients were assessed by parameters including spinal mobility, sacral inclination angle, lumbosacral angle, and sacral horizontal angle. Spinal mobility included the maximal range of motion of lumbar flexion and extension. The value of the sacral inclination angle was significantly higher and correlated with lumbar extension in chronic low back pain patients ( P<0.005, r=0.32). There was no statistical difference or correlation in lumbosacral and sacral horizontal angles and spinal mobility between the two groups ( P>0.05). Chronic low back pain affects the lower lumbar spine and limits the maximal range of;lumbar extension.     

Defining radiographic criteria for flexion-extension studies of the cervical spine.

STUDY OBJECTIVE: We sought to describe and measure 3 radiographic variables in normal male volunteers and determine whether these variables could be useful in establishing more objective radiographic criteria for evaluation of flexion-extension studies of the cervical spine. In addition, we hypothesized that patients with a normal cervical spine should not have greater than 2 mm of subluxation present with flexion or extension. METHODS: A prospective, observational study of normal male volunteers between the ages of 18 and 40 years was performed. We obtained radiographs of all participants in neutral, flexion, and extension positions and measured the amount of subluxation and interspinous distance, as well as the degree of vertebral angulation between C3 and C7. RESULTS: One hundred male volunteers were included in the study. Subluxation during flexion (compared with neutral) was greater than 2 mm in none of the participants at each level from C3 to C7 (95% confidence interval [CI] 0 to 3.6); subluxation in extension was greater than 2 mm in one participant at one level from C3 to C4 (95% CI 0 to 5.5) and none of the participants at each of the remaining 3 levels from C4 to C7 (95% CI 0 to 3.6). Comparing flexion with the neutral position, the mean vertebral angulation and SD were 24.2 degrees and 13.3 degrees, and the 95% certainty interval (CEI) was -1.9 to 50.2. Comparing extension with the neutral position, the mean vertebral angulation was 14.1 degrees, with an SD of 13.3 degrees, and the 95% CEI was -4.6 to 32.8. The mean change in interspinous distance between the neutral position and flexion varied from 1.2 to 4.6 mm (SD 1.7 to 2.4 mm), depending on the level of cervical spine studied. When comparing the neutral position and extension, the mean change in interspinous distance varied from 1.2 to 2.2 mm (SD 1.7 to 1.9). CONCLUSION: Currently, there are no clinically validated criteria for evaluating flexion-extension studies of the cervical spine. Our study suggests that subluxation greater than 2 mm in men 18 to 40 years of age may be a useful variable for further study as an indicator of ligamentous injury. Interspinous distance and vertebral angulation appear less likely to have useful clinical application.     

Does location of vertebral deformity within the spine influence back pain and disability?

OBJECTIVE: Vertebral deformity is associated with back pain and disability. The aim of this analysis was to determine whether location within the spine influences the strength of association between vertebral deformity, back pain and disability. METHODS: Men and women aged 50 years and over were recruited from population registers in 30 European centres. Subjects were invited for an interviewer administered questionnaire, and for lateral spinal radiographs. The questionnaire included questions about back pain, general health and functional ability. The spinal radiographs were evaluated morphometrically and vertebral deformity defined according to the McCloskey-Kanis method. RESULTS: 756 (11.7%) men and 885 (11. 8%) women had evidence of one or more vertebral deformities. Among women with a single deformity, after adjusting for age and centre, those with a lumbar deformity were more likely than those with a thoracic deformity to report back pain, both currently (OR=1.4; 95% CI 1.0, 2.0) and in the past year (OR=1.5; 95% CI 1.0, 2.3). No association was observed in men. Among women with two deformities, those with adjacent deformities were more likely than those with non-adjacent deformities to report poor general health (OR=2.2; 95%CI 0.9, 5.6), impaired functional ability (OR=1.9; 95%CI 0.8, 4. 7) and current back pain (OR=2.1; 95%CI 0.9, 4.9), though none of these associations were statistically significant. By contrast, among men, non-adjacent deformities were associated with impaired functional ability compared with those with adjacent deformities. CONCLUSION: Location within the spine influences the strength of association between self reported health factors and vertebral deformity.     

Loading effects of anterior cervical spine fusion on adjacent segments

Adjacent segment degeneration typically follows anterior cervical spine fusion. However, the primary cause of adjacent segment degeneration remains unknown. Therefore, in order to identify the loading effects that cause adjacent segment degeneration, this study examined the loading effects to superior segments adjacent to fused bone following anterior cervical spine fusion. The C3–C6 cervical spine segments of 12 sheep were examined. Specimens were divided into the following groups: intact spine (group 1); and C5–C6 segments that were fused via cage-instrumented plate fixation (group 2). Specimens were cycled between 20° flexion and 15° extension with a displacement control of 1°/second. The tested parameters included the range of motion (ROM) of each segment, torque and strain on both the body and inferior articular process at the superior segments (C3–C4) adjacent to the fused bone, and the position of the neutral axis of stress at under 20° flexion and 15° extension. Under flexion and Group 2, torque, ROM, and strain on both the bodies and facets of superior segments adjacent to the fused bone were higher than those of Group 1. Under extension and Group 2, ROM for the fused segment was less than that of Group 1; torque, ROM, and stress on both the bodies and facets of superior segments adjacent to the fused bone were higher than those of Group 1. These analytical results indicate that the muscles and ligaments require greater force to achieve cervical motion than the intact spine following anterior cervical spine fusion. In addition, ROM and stress on the bodies and facets of the joint segments adjacent to the fused bone were significantly increased. Under flexion, the neutral axis of the stress on the adjacent segment moved backward, and the stress on the bodies of the segments adjacent to the fused bone increased. These comparative results indicate that increased stress on the adjacent segments is caused by stress-shielding effects. Furthermore, increased stress and ROM of the adjacent segments after long-term bone fusion may accelerate degeneration in adjacent segment.     

An extensive vertebral hydatidosis revealed by a lumbosciatica

The vertebral hydatidosis is uncommon. It causes problems in diagnosis and in management. A case of an extensive vertebral hydatidosis with few symptoms is reported. A 21-year-old man has consulted for recurrent lumbosciatica that has been evolving for 1 year. Clinical exam was normal. Plain radiographic films disclosed a lytic lesion throughout the bodies of L4 and L5 and calcifications thrown on the liver area. The computed tomography (CT) and the magnetic resonance (MR) images revealed multicystic bony lesions involving the lumbar spine with extension into the spinal canal. Abdominal ultrasound showed also cyst lesions in the right kidney and in the liver. The diagnosis of vertebral and abdominal (liver and kidney) hydatidosis was retained. Four sets of 4-week albendazole cures were given with a 2-week interval in between. Our case of extended vertebral hydatidosis with few symptoms confirms the clinical latency and diagnosis difficulties usually encountered in this disease. This often leads to a late diagnosis of the stage of spinal cord compression. Radiological diagnosis and determination of extension of the hydatid cyst are usually provided by CT and MRI. Vertebral hydatidosis should be evoked in lumbosciatica especially in endemic regions.     

Kyphotic angle correction and neurological status evaluation after operation in spinal tuberculosis patients: Single center retrospective study

BackgroundPrevious studies have indicated that correction of an established kyphosis in spine tuberculosis is both difficult and hazardous. There has not been any publication about evaluation of surgical correction of spine tuberculosis in Indonesia, despite of high incidence of spine tuberculosis cases. Therefore, we evaluated the outcome of kyphotic angle correction and neurological status after surgery of spinal tuberculosis patients for better understanding.MethodsRetrospectively, 96 patients with spinal tuberculosis that underwent operation in Soeharso Orthopedic Hospital from June 2016 to July 2019 were selected. Operation procedure includes laminectomy, debridement and posterior stabilization. We obtained plain x-ray of spine to evaluate the kyphotic deformity before and after surgery. We also examined neurological status of the patient before and after surgery.ResultsThe average pretreatment kyphotic angle in thoracic tuberculosis was 33.69° (range 8°–86°), which improved into a significant change to 13.27° (range 0°–56°). Correction angle was <25° in 34 people, 25°–50° in 17 people, and >50° in 4 people. While in the lumbar tuberculosis, it was 25.52° (range 6°–80°), and improved into 11.51° (range 2°–48°). Correction angle was <25° in 35 people, 25°–50° in 4 people, and >50° in 2 people. Improved neurological deficit was shown in 12% of patient with lumbar tuberculosis, and the rest had constant neurological deficit. While in thoracic tuberculosis found that 7% have improved neurological deficit and the rest is constant. None of them have worsen neurological status after the surgery.ConclusionsSurgical treatment for kyphotic deformity in patient with thoracolumbar tuberculosis are effective and safe, even in high corrective angle (>50°).     

Pinealectomy induces malformation of the spine and reduces the mechanical strength of the vertebrae in Atlantic salmon, Salmo salar

This study describes the long-term effects of surgical ablation of the pineal gland on the spine of 3-yr-old Atlantic salmon (Salmo salar L.) with a mean weight of 3.2 kg. Radiographic examinations showed that 82% of the pinealectomized fish developed marked lateral (scoliosis) and dorso-ventral spinal curvatures. The proportions of the individual vertebral bodies and their mechanical properties were also altered. The stiffness, yield limit and resilience of the vertebral bodies, as measured by compression in the cranio-caudal direction, were significantly lower in the pinealectomized than in the sham-pinealectomized group. Calcium, phosphorous and total mineral content of the vertebral bodies were also significantly lower in the pinealectomized fish, while these parameters were similar in scales in the two groups. Alterations of the spinal curve accompanied by changes in the proportions, mechanical strength and mineral content of the vertebral bodies of the pinealectomized salmon indicate that melatonin has several functions related to vertebral bone growth. As the lesions found in salmon are similar to the spinal malformations observed in avian species and mammals after pinealectomy, this study strengthens the hypothesis of a phylogenetically conserved function of the pineal gland related to skeletal development.     

一期前路病灶清除钛网植骨后路内固定术治疗胸腰椎结核疗效探讨

选择2006年1月至2015年1月湖北省宜都市第一人民医院采用一期前路病灶清除、钛网植骨融合及后路内固定治疗的胸腰椎结核患者45例;其中男20例,女25例;年龄23~72岁,平均(46.02±10.13)岁;胸椎结核20例,胸腰段结核10例,腰椎结核8例,腰骶段结核7例;对患者手术时间、术中出血量,手术前后的视觉模拟评分法(visual analogue scale,VAS)、Frankel分级、脊柱后凸角、血红细胞沉降率(ESR)变化,以及并发症发生和植骨融合情况进行评价。45例患者平均手术时间(230.27±15.86)min,术中出血(489.89±35.87)ml。患者术前VAS评分为(7.50±1.13)分,术后3个月随访时降低至(0.89±1.67)分,差异有统计学意义(t=22.23,P<0.001)。术后神经功能改善情况Frankel分级为:术前7例B级患者中,4例恢复至E级,3例恢复至D级;术前8例C级和15例D级患者全部恢复至E级。脊柱后凸角度术前为(33.93±7.01)°,术后3个月降低至(15.07±3.45)°,差异有统计学意义(t=16.20,P<0.001);ESR由术前的(69.75±14.62)mm/1h降低至术后3个月的(13.16±5.27)mm/1h,差异有统计学意义(t=23.81,P<0.001)。45例患者随访24~70 个月,术后均无严重并发症发生,植骨均获得融合,无内固定松动及断裂出现。作者认为,一期前路病灶清除钛网植骨联合后路内固定治疗胸腰椎结核能有效矫正脊柱畸形,重建脊柱稳定性,提高脊柱结核的治愈率。