动态MRI检测颈椎健康者、颈肩部不适者脊髓型颈椎病未确诊及确诊者的价值

背景:目前MRI对于颈椎病的检查多是常规的中立仰卧位静态平扫,是在非运动和非承重的条件下完成的,容易忽略脊髓在人体中承重和动态下脊髓的器质性改变。目的:分析颈椎动态MRI结合临床表现早期诊断脊髓型颈椎病的临床意义。方法:对随机抽取的正常人群10名(正常组)、有颈肩部不适的亚健康人群20名(亚健康组)、有脊髓型颈椎病症状体征但常规MRI不支持的患者20名(MRI正常脊髓型颈椎病组)、符合现行脊髓型颈椎病诊断标准的患者20名(脊髓型颈椎病组)进行JOA评分,颈椎正侧位片、颈椎中立位MRI及颈椎动态MRI检查,并随访18个月以上,观察4组研究对象各项观察指标的变化情况及4组人群的转归情况。结果与结论:脊髓型颈椎病组20例患者均在入组半年内手术治疗;MRI正常脊髓型颈椎病组20例中有16例在入组16个月内行手术治疗,其中4例入组1年内在中立位MRI检查尚无明显改变时即行手术治疗,12例在入组1年后颈椎中立位MRI也已有脊髓型颈椎病的典型改变时行手术治疗,前者治疗效果明显优于后者(P0.05);亚健康组有4例出现了脊髓型颈椎病的症状体征,发现此4例患者动态颈椎MRI检查均有椎管变窄脊髓受压征象,但中立位MRI仅发现1例由此改变,且此例动态MRI在入组12个月时已经发现脊髓受压。在正常组随访中动态MRI与中立位MRI检查均发现1例有椎管变窄脊髓受压征象,但患者没有任何不适症状,考虑为假阳性;二者假阳性率相同。结果表明,颈椎动态MRI检查较中立位MRI能够更早期、更真实客观地发现脊髓受压征象;在临床症状、体征检查的基础上将常规的中立位MRI检查与动态MRI检查相结合将会更早期发现脊髓型颈椎病。     

胆道闭锁肝内外胆系组织病理形态学分析

目的 通过胆道闭锁（BA）肝门纤维块、肝脏组织的病理及其超微结构观察，对肝门成纤维细胞分化程度进行评分，并与肝纤维化分级进行相关分析。方法 选取BA患儿作为研究对象，术中取肝门纤维块及肝脏组织标本；研究同期选取疑似BA经术中胆道造影除外BA，诊断为胆汁淤积综合征和先天性胆管扩张症患儿作为对照组，留取肝脏组织标本。在光镜和电镜下观察标本的病理改变，以及肝细胞、毛细胆管和肝门成纤维细胞的超微结构。采用SPSS14．0软件，半定量比较BA与对照组肝脏纤维化的差异，检验肝门纤维块成纤维细胞活跃程度与肝纤维化分级的相关性。结果 2005年7月至2006年5月复旦大学附属儿科医院收治的21例BAKasai根治术病例，手术平均年龄（66±20）d；对照组为5例胆汁淤积综合征和10例先天性胆管扩张症患儿。BA组肝组织病理改变主要是肝内门脉区胆管炎症及纤维化形成，肝纤维化程度明显高于同年龄胆汁淤积综合征和先天性胆管扩张症患儿；肝门纤维块毛细胆管增生，部分管腔闭锁、狭窄，腔内炎细胞浸润及部分淤胆，大量间质成分增生；电镜下肝门成纤维细胞活跃、肝脏毛细胆管上皮微绒毛缺失、肝细胞及肝血窦内电子致密物质增多及部分毛细胆管扩张；肝门成纤维细胞分化程度与肝组织纤维化程度相关（P=0．04）。结论 BA肝组织病理改变主要是肝内门脉区胆管炎症及严重纤维化形成；超微结构改变提示肝门部成纤维细胞活跃，其分化程度与肝纤维化程度相关。     

后侧位内、外括约肌联合切断术治疗陈旧性肛裂疗效观察

目的：观察后侧位内、外括约肌联合切断术治疗陈旧性肛裂的临床疗效。方法选取我院2012年2月~2014年2月收治的66例陈旧性肛裂患者为研究对象,随机将其分为两组,对照组患者采取侧位或后位切扩术治疗,观察组患者给予后侧位内、外括约肌联合切断术治疗,对两组治疗效果及并发症情况进行比较。结果观察组痊愈率94.44%,感染发生率5.56%,对照组痊愈率80.00%,感染发生率为20%,两组比较差异有统计学意义,约0.05。结论相比侧位或后位切扩术,后侧位内、外括约肌联合切断术治愈率高,并发症少,可作为陈旧性肛裂治疗的重要手段。     

妊高征胎盘组织的病理改变

目的观察妊娠高血压综合征(妊高征)胎盘组织病理改变,探讨妊高征胎盘缺血缺氧的病理基础.方法采用HE染色法观察正常胎盘30例、妊高征胎盘25 例的病理表现,比较出妊高征胎盘的病理改变.结果与正常足月胎盘比较,妊高征胎盘中细胞滋养细胞明显增生,滋养细胞下基底膜增厚,绒毛间质纤维蛋白沉积,合体细胞结节增多,合体细胞出芽,发生纤维素样坏死的绒毛增多,绒毛血管增多,绒毛大部分不成熟.结论妊高征胎盘组织发生细胞滋养细胞增生等改变是其胎盘缺血缺氧的病理基础.     

颈椎棘突骨折累及后方韧带复合体损伤对羊颈椎生物力学稳定性的影响

目的通过体外羊标本模拟颈椎棘突骨折累及后方韧带复合体(posterior ligamentous complex,PLC)损伤对颈椎生物力学稳定性的影响,探讨颈椎后方结构在维持颈椎稳定性中的作用。方法将新鲜羊颈椎C3~6标本24具随机平均分为3组:正常对照组(A组);单纯颈椎棘突骨折组(B组);颈椎棘突骨折合并PLC损伤组(C组)。在1.5 N·m力矩加载下,分别测量各组在前屈、后伸、左右侧弯和左右旋转6种工况下颈椎活动度(range of motion,ROM),使用单因素方差分析比较3组之间的ROM差异。结果单纯颈椎棘突骨折对羊颈椎稳定性影响不大,各工况下ROM同正常对照组比较差异无统计学意义(P0.05);颈椎棘突骨折合并PLC损伤组在前屈、后伸及左右旋转工况下ROM显著增加,同正常对照组相比,差异具有统计学意义(P0.05),颈椎棘突骨折合并PLC损伤组在左右侧弯工况下同正常对照组比较ROM变化不显著,差异无统计学意义(P0.05)。结论单纯颈椎棘突骨折本身并不影响颈椎整体稳定性,但颈椎棘突骨折伴有PLC损伤时可造成颈椎不稳,需要手术干预。     

MRI在胸腰段骨折合并后侧韧带损伤中的诊断价值

目的　评估矢状面脂肪抑制 T2加权像 MRI在胸腰段骨折合并后侧韧带损伤中的诊断价值。方法　对 34例胸腰段骨折的患者 ,术前均进行了棘突间触诊、X线平片及 MRI等检查。除常规 MRI检查外 ,还增加了矢状面脂肪抑制 T2加权像。手术选择后侧入路 ,术中仔细探查后侧韧带的复合损伤。结果　 14例患者触诊发现棘突间距离增大 ,2 1例行 X线平片检查出现相同结果 ,30例 MRI检查高度怀疑后侧韧带复合损伤。根据 MRI的检查结果 ,2 7例患者疑有棘上韧带损伤 ,30例棘间韧带损伤 ,9例黄韧带损伤。术中探查发现 ,棘上韧带损伤 2 8例 ,棘间韧带损伤…     

肝脏局灶性结节增生的CT及MRI诊断的临床价值研究

目的：比较CT及MRI检查在肝脏局灶性结节增生诊断中的应用价值。方法选取我院收治的30例肝脏局灶性结节增生患者作为研究对象,20例行CT检查,10例行MRI检查,比较CT及MRI检查的图像特点及诊断结果。结果 CT检查检出21个病灶,病理检查检出23个病灶,CT检查的FNH病灶检出率为91.3%;MRI检查检出10个病灶,病理检查检出11个病灶,MRI检查的FNH病灶检出率为90.9%。 MRI与CT检查的病灶检出率相比,差异不具有统计学意义,>0.05。结论典型的肝脏局灶性结节增生表现为动脉期均匀强化,实质期及门脉期均为等密度或高密度强化,MRI和CT检查均能明确诊断此类肝脏局灶性结节增生,对于不典型病变,应注意与肝血管瘤、肝细胞癌及腺瘤加以鉴别。     

120例肝硬变弹力纤维分布的初步研究

用维多利亚蓝染色。对120例肝硬变中弹力纤维的分布行光镜观察。标本为手术活检所得。其中肝硬变伴慢性活动性肝炎(CAH)84例,胆汁性肝硬变22例,肝硬变伴肝癌14例。另取10例正常肝组织作对照。各例同时做HE、VG和网状纤维染色对照观察。纤维增生程度分轻、中、重3级。结果各组都有不同程度的弹力纤维增生,伴CAH组中一重度增生占95%,胆汁性肝硬变组占     

阿拉坦五味丸治疗萎缩性胃炎110例效果观察

目的 观察阿拉坦五味丸治疗慢性萎缩性胃炎的临床疗效.方法 110例慢性萎缩性胃炎随机分为治疗组和对照组,治疗组用阿拉坦五味丸治疗,对照组仅予一般处理及对症处理.观察两组临床症状改善及病理组织掌改善情况.结果 主观症状治疗组临床疗效明显优于对照组,治疗组组织学改变改善,显著优予对照组.结论 阿拉坦五味丸治疗萎缩性胃炎疗效显著优于对照组.     

腰椎后路经皮微创与传统开放手术影响竖脊肌形态学改变的比较

背景:微创与传统开放手术效果的比较,目前仅涉及患者症状、体征、切口大小及手术出血量、术后影像学等方面的变化,无法确切表达微创优点。目的:以竖脊肌组织病理学变化为量化标准,比较经皮微创与传统开放腰椎后路手术的效果。方法:24只兔随机分为3组,开放手术组自髂棘平面起沿棘突向头侧端做7cm皮肤切口,沿棘突两旁剥离竖脊肌,牵开竖脊肌,维持0.5h和一定压力;微创组在第5,7腰椎棘突中线旁两侧0.5～1.0cm分别插入导针至腰椎板位置,沿导针置入逐级扩张和工作通道,器械到位后维持0.5h;正常对照组不进行任何干预。分别于术后3d、1,2,3周及1,3,6个月,取手术区域椎板附近深部竖脊肌肌肉标本进行病理组织学检测及透射电镜观察。结果与结论:开放手术组早期呈现不同程度的横纹肌细胞间水肿、炎细胞浸润、蜡样变性及液化性坏死,肌组织的坏死逐渐明显,并出现片状的小群状肌萎缩或肌纤维同型化,后期主要是肌纤维同型性成群、萎缩、大小变异以及少量中央核肌纤维再生,明显的脂肪浸润、单核增生、间质浸润以及瘢痕形成;电镜下超微结构改变与光镜结果一致,可见肌纤维排列紊乱,部分溶解,线粒体肿胀,脂肪变性,大量的胶原纤维和成纤维细胞增生。微创组早期呈现轻度炎细胞浸润,肌组织坏死不明显,后期肌纤维大小及构成比例接近正常对照组,瘢痕化、脂肪化也不明显。提示手术创伤程度与竖脊肌的组织学改变密切相关,经皮微创手术可以明显降低腰椎后路手术对于竖脊肌肉的损伤。     

Sexual dimorphism of the posterior cervical spine muscle attachments

Cervical spinal injury and neck pain are common disorders with wide physical implications. Neck pain and disability are reported to occur in females more often than in males, and chronic or persistent neck pain after whiplash is twice as common in females. Female athletes also sustain a higher percentage of concussions compared to male athletes. Still, while sexual differences in clinical presentation and outcome are well-established, the underlying etiology for the disparity remains less clear. It is well-established that the origin and insertion landmarks of posterior neck muscles are highly variable, but we do not know if these interindividual differences are associated with sex. Expanding our knowledge on sexual dimorphism in the anatomy of the cervical muscles is essential to our understanding of the possible biomechanical differences between the sexes and hence improves our understanding as to why females suffer from cervical pain more than males. It is also of paramount importance for accurate planning of posterior cervical spine surgery, which cuts through the posterior cervical musculature. Therefore, our main objective is to characterize the anatomy of posterior neck musculature and to explore possible sexual differences in the location of their attachment points. Meticulous posterior neck dissection was performed on 35 cadavers, 19 females, and 16 males. In each specimen, 8 muscle groups were examined bilaterally at 45 osseous anatomical landmarks. Muscles and their attachment sites were evaluated manually then photographed and recorded using Microscribe Digitizer technology built into 3D models. A comparison of attachment landmarks between males and females for each muscle was conducted. Out of the eight muscles that were measured, only two muscles demonstrated significant sex-related anatomical differences—Spinotranversales (splenius capitis and cervicis) and Multifidus. Male Spinotransversales muscle has more attachment points than female. It showed more cranial insertion points in the upper cervical attachments (superior nuchal line, C₁ posterior tubercle, and mastoid process) and more caudal insertion points in the spinous processes and transverse processes of the lower cervical and upper thoracic vertebrae. Thus, the male subjects in this study exhibited a greater coverage of the posterior neck both cranially and caudally. Female Multifidus has more attachment points on the spinous processes and articular processes at middle and lower cervical vertebrae and at the transverse processes of the upper thoracic vertebrae. All remaining muscles exhibited no sexual differences. Our findings highlight, for the first time, a sexual dimorphism in attachment points of posterior cervical musculature. It reinforces the notion that the female neck is not a scaled version of the male neck. These differences in muscle attachment could partially explain differences in muscle torque production and range of motion and thus biomechanical differences in cervical spine stabilization between sexes. It sheds a much-needed light on the reason for higher whiplash rates, concussion, and chronic cervical pain among females. Surgeons should take these sexual morphological differences into consideration when deliberating the best surgical approach for posterior cervical surgery.     

大鼠脊髓损伤模型的解剖学参考定位

目的探查大鼠椎骨解剖学位置和形态特点,为制作大鼠脊髓损伤模型定位提供参考和解剖学依据。方法将20只Wistar大鼠按照体质量分成2组,每组10只。轻体质量组：120～150g;重体质量组：200-250g。对各组大鼠脊柱区进行解剖及椎骨位置、形态特点观察。结果大鼠颈椎7块,其中第2颈椎棘突突出最明显。胸椎13块,其中第2胸椎棘突突出最明显,并向上连结一膨大软骨;第9、10、11胸椎棘突之间距离最为靠近,且第9胸椎以上棘突倾向尾侧．第10胸椎棘突呈中立位,第11胸椎棘突以下方向倾向头侧。腰椎6块,第1腰椎棘突与脊柱两侧银白色腱膜第一个相交接处对应。结论依据脊柱两侧白色腱膜和椎骨棘突形态位置特点参考定位简单、精确,为大鼠脊髓损伤模型的制作提供了解剖学依据和有力保证。     

慢性颈脊髓压迫模型大鼠构建及评价

背景：在脊髓型颈椎病脊髓损伤发生机制的研究过程中,建立稳定且同人类体内疾病演变过程相似的疾病模型对于研究脊髓型颈椎病发病机制至关重要。 目的：构建慢性颈脊髓压迫模型,观察该模型病理生理变化特点,进一步明确脊髓型颈椎病受压脊髓组织的病理改变。 方法：30只SD大鼠随机均分为对照组、轻度压迫组、重度压迫组。将不同大小吸水性压迫材料聚乙烯醇丙烯酰胺互穿网络水凝胶植入C5-C7椎板下,制作慢性颈脊髓压迫动物模型,对照组不植入压迫材料。 结果与结论：MRI检查显示两压迫组大鼠出现不同程度的椎管狭窄和脊髓压迫,而对照组椎管宽度正常无脊髓压迫。电生理检测显示两压迫组大鼠运动诱发电位潜伏期较对照组明显延长且振幅明显降低(P < 0.05)。神经元免疫荧光染色显示对照组大鼠脊髓有大量形态规则的神经元,而两压迫组大鼠神经元计数明显减少且神经元胞体形态明显皱缩,脱髓鞘现象明显,3组间比较差异有显著性意义(P < 0.05)。压迫组大鼠脊髓压迫节段发现较多凋亡细胞,而对照组未发现。说明构建的大鼠慢性颈脊髓压迫模型符合脊髓型颈椎病的病理改变,且手术操作简便,不易感染死亡率低;神经元损伤、脱髓鞘改变和凋亡机制参与了大鼠慢性颈脊髓压迫损伤的发生发展过程。     

The cat vertebral column: stance configuration and range of motion

This study examined the configuration of the vertebral column of the cat during independent stance and in various flexed positions. The range of motion in the sagittal plane is similar across most thoracic and lumbar joints, with the exception of a lesser range at the transition region from thoracic-type to lumbar-type vertebrae. The upper thoracic column exhibits most of its range in dorsiflexion and the lower thoracic and lumbar in ventroflexion. Lateral flexion is limited to less than 5° at all segments. The range in torsion is almost 180° and occurs primarily in the midthoracic region, T4-T11. Contrary to the depiction in most atlases, the standing cat exhibits several curvatures, including a mild dorsiflexion in the lower lumbar segments, a marked ventroflexion in the lower thoracic and upper lumbar segments, and a profound dorsiflexion in the upper thoracic (above T9) and cervical segments. The curvatures are not significantly changed by altering stance distance but are affected by head posture. During stance, the top of the scapula lies well above the spines of the thoracic vertebrae, and the glenohumeral joint is just below the bodies of vertebrae T3-T5. Using a simple static model of the vertebral column in the sagittal plane, it was estimated that the bending moment due to gravity is bimodal with a dorsiflexion moment in the lower thoracic and lumbar region and a ventroflexion moment in the upper thoracic and cervical region. Given the bending moments and the position of the scapula during stance, it is proposed that two groups of scapular muscles provide the major antigravity support for the head and anterior trunk. Levator scapulae and serratus ventralis form the lateral group, inserting on the lateral processes of cervical vertebrae and on the ribs. The major and minor rhomboids form the medial group, inserting on the spinous tips of vertebrae from C4 to T4. It is also proposed that the hypaxial muscles, psoas major, minor, and quadratus lumborum could support the lumbar trunk during stance. Received: 2 January 1997 / Accepted: 23 September 1997     

Three muscles in the upper costovertebral region: Description and clinical anatomy

The aim of the study was to describe three small muscles in the upper costovertebral region that have close proximity to the ventral rami of the lower cervical and upper two thoracic spinal nerves. The study was performed using both anterior and posterior approaches to the costovertebral region. Twenty‐five human cadavers, 15 males and 10 females with a mean age of 50 years and with normal spines, constituted the material of the study. Dissection revealed the presence of three triangular muscles that extended from the transverse processes of the seventh cervical through second thoracic vertebrae to the upper borders of the necks of the first through third ribs, respectively. The second and third muscles are described and reported for the first time. The ventral rami of the lower cervical and upper two thoracic spinal nerves emerged through narrow gaps between the described muscles and the bodies of seventh cervical and upper two thoracic vertebrae, respectively. The lateral branch of the dorsal ramus of the corresponding spinal nerve issued posteriorly between the muscle and the articular capsule of the zygapophyseal joint. It then curved round the posterior aspect of the muscle and passed through the gap between the muscle and the levator costarum, after supplying them both. We suggest that these three muscles were suggested to share a common embryogenesis with the intertransverse muscles. In addition, this study suggests that the three muscles described herein could be one of the potential causes of thoracic outlet syndrome. Clin. Anat. 22:352–357, 2009. © 2009 Wiley‐Liss, Inc.     

New dysostosis showing multilevel absence of vertebral pedicles: unique developmental anomaly of vertebral arches?

We report on an apparently normal child who shows hypopaplasia of the vertebral pedicles and posterior arches of several cervical, thoracic, and lumbar vertebrae with normally fused spinous apophyses, hypoplastic sacrum, lumbar epidural lipomatosis, synostoses of some cervical vertebral disks, and sacral spina bifida. The most likely mechanism is an abnormal differentiation of the spinal processes, due most probably to an absence of differentiation in cartilage of the dense mesenchyme forming their most anterior part. Because the anomalies affect multiple levels, we highly suspect a genetic basis to this unusual dysostosis affecting the development of the posterior sclerotomes.     

颈椎后路术后颈椎曲度不良与疗效的相关性

目的：探讨颈椎后路手术治疗颈椎退变性疾病后颈椎曲度不良与疗效的相关性。方法：采用颈椎后路减压术治疗颈椎退变性疾病患者85例,其中全椎板减压术26例、单开门椎管扩大成形术39例和单开门棘突重建扩大成形术20例,观察手术后颈椎后凸畸形对治疗效果的影响。结果：经6-72个月,平均18个月随访,颈椎后凸与否,各组之间神经功能改善率差异无统计学意义（P〉0.05）;单开门椎管扩大成形术与单开门棘突重建椎管扩大成形术,术后颈椎后凸发生率低于全椎板减压术（P〈0.05）;颈椎无后凸与轻度后凸（与A、B、C的对应关系）畸形之间的轴性症状发生率无差异,但与明显后凸组相比有差异性（P〈0.05）。结论：颈椎后路减压术是治疗颈椎退变性疾病常用的手术方法,具有椎管容积扩大明显等优点。但减少手术对后方肌肉韧带复合体损伤并对此复合体进行有效修复,可以减少颈后凸畸形和轴性症状发生,提高手术效果。     

胸椎后凸角X线测量及其意义

目的提供不同年龄组正常人胸椎后凸角的数据标准。方法选用462例6～102岁正常人胸部侧位片,分别进行胸椎后凸角X线测量。结果代表胸椎后凸程度的上、下部胸椎后凸角值,各组值分别是儿童组为7.96°±1.36°,4.98°±0.67°;青年组为10.73°±2.28°,5.23°±1.82°;中年组为12.64°±1.31°,6.49°±1.28°;老年组为17.88°±1.34°,9.84°±0.98°;长寿组为21.57°±1.28°,13.58°±0.96°。结论胸椎后凸角值随年龄的增大而增大,符合生理性改变。     

颈椎阻滞椎X线表现及特征

目的　探讨颈椎阻滞椎的X线表现及特征。 方法　回顾性分析125例颈椎阻滞椎X线资料,男性45例,女性80例,年龄24~75岁,平均年龄41.9岁,男女比例为1:1.77。分析其阻滞椎的发生节数、融合部位、骨赘发生、颈椎前凸曲度以及上、下椎间隙等情况。 结果　本组病例中阻滞椎累及2个椎体100例,累及3个椎体5例,累及4个椎体17例,累及5个椎体3例。单节段阻滞椎以C2~3最多,共43例（43%）;其次是C3~4,共16例（16%）。融合部位：椎体及附件的同时融合82例（65.6%）,单纯椎体融合28例（22.4%）。颈椎曲度变直或反张36例（28.8%）。椎体前/后缘骨赘110例（88%）;上椎间隙狭窄7例（5.6%）;下椎间隙狭窄15例（11.7%）;棘突融合52例（41.6%）;前纵韧带钙化19例（15.2%）;项韧带钙化17例（13.6%）;颅底凹陷症15例（12%）。 结论　颈椎阻滞椎常表现为单节段的融合,椎体及附件的同时融合比单纯椎体融合多见。阻滞椎常伴有邻近节段的退行性改变及颅底凹陷。