脊柱手术中脊髓损伤的危险因素分析及其预防策略

目的探讨脊柱外科术中导致脊髓损伤的危险因素及其预防策略。方法报告2000年2月～2006年3月,作者共手术治疗脊柱患者1357例次。分组按照术前危险因素:临床因素、影像学因素、病理因素和手术因素4大部分。干预措施包括:出血倾向患者术前术中应用止血药物或成分输血,控制性降压,激素,高压氧等。结果在1357例中,根据界定标准,共有43例符合高危患者的标准,其中颈椎21例,胸椎19例,腰椎3例。结论胸椎的危险性及发生率明显高于颈椎,腰椎最少。年龄不是影响术中脊髓损伤的主要原因。多节段骨性狭窄的颈椎前路手术是脊髓损伤的危险因素。颈椎手术中高血压和糖尿病患者的出血控制相对困难。脊柱侧凸的术前牵引,解除前方压迫的经椎间孔途径减压,以及脊髓肿瘤术中应用"布袋"技术可以减少脊髓损伤。高速磨钻可以避免胸椎黄韧带骨化和颈椎OPLL患者的脊髓损伤。激素和高压氧可以促进脊髓损伤的恢复。     

手术治疗胸腰段脊柱脊髓损伤56例临床观察

目的探讨胸腰段脊柱脊髓损伤治疗方法的选择及其临床疗效。方法根据患者的病情及骨折类型选用前路或后路椎管减压、钉板或钉棒系统内固定、植骨融合术并结合甲基强的松龙冲击疗法治疗胸腰段脊柱脊髓损伤,观察术前术后椎体高度和脊髓损伤平面以下感觉、运动恢复程度。结果 56例经12～36月随访,术后椎体高度和脊髓损伤平面以下皮肤感觉、下肢运动功能不同程度恢复,未见内固定物松动、断裂,无明显后突畸形发生。结论选用前路或后路椎管减压、钉板或钉棒系统内固定、植骨融合术并结合甲基强的松龙冲击疗法治疗胸腰段脊柱脊髓损伤可以有效恢复脊柱序列和椎管容积,为受伤脊髓修复创造条件。     

颈胸段脊柱脊髓伤的诊断及前路手术治疗

目的 探讨颈胸段脊柱脊髓损伤的临床特点、诊断及颈胸段前路减压、植骨、Orion钢板内固定术的治疗作用。方法 分析26例颈胸段脊柱骨折、脱位患者的临床表现;行颈胸段前路C7、T1、C6－7或C7－T1椎体次全切除、植骨及Oron锁定型颈椎前路钢板固定术。结果 颈胸段脊柱脊髓损伤患者通常表现为C8－T1或T2相应节段脊髓神经根症状,10例伴有窦性心动过缓、8例出现低血压、7例出现Horner征等交感节刺激症状。所有患者随访3－20个月,植骨均在3－4个月内完全融合,20例脊髓神经功能有不同程度的改善,上述交感神经节刺激疾病缓解,1术后出现暂时性声音嘶哑。结论 颈胸段脊柱脊髓损伤根据其临床特点、影像学表现可确定诊断;颈胸段前路减压、植骨、Orion钢板内固定术对颈胸段脊柱脊髓损伤具有较好的疗效,Orion钢板有助于植骨节段融合、重建和稳定颈胸段脊柱。     

强直性脊柱炎脊柱骨折的治疗

目的 了解强且性脊柱炎(AS)脊柱骨折治疗的特点及注意事项。方法对19例AS脊柱骨折病例进行回顾性分析硬随访,19例中颈椎骨折11例,9例发生在C5-7间;胸腰椎骨折8例,7例为应力骨折,均发生存T10-L2间。二柱骨折16例。9例并发脊髓损伤,其中8例为颈椎骨折。所有19例患者均接受了手术治疗。颈椎骨折或脱位采用了4种手术方式,其中9例做了前路间盘切除或椎体次全切除、椎间值骨加钢板内固定术。胸腰椎骨折也做了4种术式,其中5例的术式为后路长节段固定加前、后联合融合,结果术岳18例患者获得了平均46．4个月的随访。并发脊髓损伤的9例患者,术后8例的神经功能有恢复。18例患者的骨折部位均已骨性愈合一术中并发脊髓损伤2例,因脑血管意外死亡1例,并发肺炎2例。结论 AS脊柱骨折好发于下颈椎及胸腰段,大多为三柱骨折,颈椎骨折并发脊髓损伤的发生率较高。胸腰椎多为应力骨折一手术治疗可使大多数患者的骨折愈合良好,神经功能有不同程度的恢复。对颈椎骨折患者,可采用前路椎体问植骨、钢板内固定的术式;而对于胸腰椎骨折,主张后路长节段固定,前、后联合植骨融合,术中及术后均可能出现并发症,应注意预防或避免。     

哈林顿棒在急性胸腰椎脊柱脊髓损伤外科治疗中的应用

哈林顿棒在急性胸腰椎脊柱脊髓损伤外科治疗中的应用王兰，关骅，李建军１９９０～１９９４年我院应用哈氏棒治疗急性胸腰椎脊柱脊髓损伤６５例，本文对哈氏棒的手术适应证及手术方法、效果进行分析探讨。４临床资料１９９０～１９９４年我科手术治疗急性胸腰椎损伤１０２...     

非相邻多节段脊柱骨折与脊髓损伤的临床诊疗策略

目的分析非相邻多节段脊柱骨折(MNSF)的受伤机制、诊断要点、治疗原则。方法 2001年1月～2008年12月,共收治48例MNSF。有41例进行了规范的康复训练,依据Frankel分级和AISA评分进行术前、术后的比较。结果 40例得到了随访,均无感染,内固定松动失败1例,植骨不融合1例,神经症状改善明显,有效率100%。结论非相邻多节段脊柱脊髓损伤,应避免漏诊。治疗应尽早实施手术,重建脊柱的稳定性,松解压迫的脊髓或神经根,另一方面强调脊髓损伤的急性期需在常规治疗的同时需早期康复。     

三柱截骨术治疗脊柱后凸并脊髓或神经根压迫症

目的:探讨脊柱后凸畸形合并脊髓或神经根压迫症的手术治疗方法。方法:采用脊柱前、中、后三柱截骨的方法,治疗脊柱后凸并脊髓压迫症17例,脊髓功能按Frankel分级,A级2例,C级3例,D级5例,E级7例;神经根压迫症5例。术中解除压迫脊髓或神经根的致压因素,同时进行矫形、内固定及植骨融合。结果:22例均获得有效减压,后凸角矫正率平均57.8%。术后脊髓功能2例A级(Frankel分级)无恢复,3例C级恢复至D级2例、恢复至E级1例,5例D级均恢复至E级,5例神经根压迫症患者症状和体征明显改善。术后4～6个月截骨间隙达到骨性融合。结论:脊柱三柱截骨手术可以同期行脊髓或神经根减压、减张、脊柱矫形和截骨间隙植骨融合以重建脊柱的稳定性,是治疗脊柱后凸并脊髓或神经根压迫症较好的方法。     

陈旧性胸腰段脊柱骨折脱位伴脊髓不全损伤的手术治疗

目的探讨脊髓侧前方减压术治疗陈旧性胸腰段脊柱骨折脱位伴脊髓不全损伤的效果。方法1992至2002年采用脊髓侧前方减压术治疗陈旧性胸腰椎骨折21例,19例获得随访。结果随访时间平均18．7个月,总有效率为90％。结论脊髓侧前方减压术对陈旧性胸腰椎骨折脱位伴脊髓不全损伤具有良好效果。     

倒置嵌夹式植骨在颈椎前路手术中的应用

目的 将倒置嵌夹式植骨(简称倒嵌式植骨)方式应用于颈椎前路减压术中，以利于固定与融合。方法 对125例颈椎损伤及脊髓型颈椎病患者实施颈椎前方减压后，将骨窗上下端修整成燕尾形槽，然后把自体髂骨的骨块制成梯形，在牵引或撑开器作用下，倒置嵌夹在槽内，完成植骨固定。结果 93例随访6个月～7年，均无移植骨向前脱出和向后移位，术后3个月摄X线片显示椎间高度无丢失、颈椎保持前屈曲度，骨块完全融合。结论 倒嵌式植骨稳定性好，符合脊柱中柱承重的生物力学原理，屈伸不受影响，剪力小，稳定性强，不需内固定，融合质量高，有利于颈椎的稳定性重构和脊髓功能的恢复。     

脊柱骨折的急诊急救与护理

随着交通和建筑意外事故的日益增加，世界范围内急性脊柱损伤的发生率已达50万-100万例／年。因脊柱组织构成的多样性，且常合并其他重要器官或脊髓的损伤，使此类损伤具有伤势严重、伤情复杂、伤残率高的特点。急性脊髓损伤病情复杂，常为复合伤，依据脊柱损伤的分型提出护理方法，即抓住“生命-神经功能-脊柱稳定性-功能康复”这条主线，将急性脊柱脊髓损伤分为有严重合并伤、有神经症状、有神经损伤倾向和单纯稳定性4型，针对不同类型患者的特点进行护理。2005年1月至2006年12月，我科对急性脊柱脊髓损伤患者采用现场急救、转运途中救护、院内急诊救治三个急救环节的急救措施，取得良好效果。     

Characteristics and surgical management of neuropathic (Charcot) spinal arthropathy after spinal cord injury

Background contextNeuropathic (Charcot) spinal arthropathy (CSA) is a rare but progressive and severe degenerative disease that develops in the absence of deep sensation, for example, after spinal cord injury. The diagnosis of CSA is often delayed as a result of the late onset or slow progression of the disease and the nonspecific nature of the reported clinical signs. Considering risk factors of CSA in combination with the common clinical signs may facilitate timely diagnosis and prevent severe presentation of the disease. However, there is a lack of data concerning the early signs and risk factors of CSA. Furthermore, the complications and outcomes after surgical treatment are documented insufficiently.PurposeTo investigate the early signs and risk factors of CSA after spinal cord injury, as well as the complications and outcome after surgical treatment.Study designRetrospective case series from a single center.Patient sampleTwenty-eight patients with 39 Charcot joints of the spine.Outcome measuresClinical signs, radiological signs, risk factors, and complications.MethodsThe case histories and radiological images of patients suffering from CSA were investigated.ResultsThe first clinical symptoms included spinal deformity, sitting imbalance, and localized back pain. Long-segment stabilization, laminectomy, scoliosis, and excessive loading of the spine were identified as risk factors for the development of the disease. Postoperative complications included implant loosening, wound healing disturbance, and development of additional Charcot joints. All patients were able to return to their previous levels of activities.ConclusionsRadiological follow-up of the entire thoracic and lumbar spine should be performed in paraplegic patients. Risk factors in combination with typical symptoms should be considered to facilitate early detection. Functional restoration can be achieved with appropriate surgical techniques.     

Charcot joint of the spine,a cause of autonomic dysreflexia in spinal cord injured patients

STUDY DESIGN: Case report of two subjects. OBJECTIVE: Charcot joints of the spine as a cause of Autonomic Dysreflexia in spinal cord lesions. SETTING: Stoke Mandeville Hospital, UK. METHOD: Two patients with long standing spinal cord lesions developed symptoms of headaches and sweating associated with sitting up and transfers. In both cases no other cause was found to account for Autonomic Dysreflexia. RESULT: Charcot Joints of the spine below the level of injury were demonstrated in both cases and symptoms resolved with prolonged bed rest. CONCLUSION: As care of spinally injured patients continues to improve, they live longer and lead a more active lifestyle, it is expected that the incidence and prevalence of Charcot's joints will increase. Therefore the knowledge and heightened awareness of this entity, early diagnosis and detection with plain X-rays for urinary surveillance, may reduce the morbidity in spinal cord injured patients.     

Infected Charcot spine

STUDY DESIGN: Case report of an infected Charcot spine following spinal cord injury. OBJECTIVE: To describe this very rare pathological condition and the results of surgical treatment. SETTING: A department of orthopaedic surgery in Japan. METHODS: A 44-year-old man presented with a destructive lesion in the lumbo-sacral spine and a fistula in his back. Anterior bone graft, percutaneous external spinal fixation, and suction/irrigation of the wound were performed. After 4 months, posterior spinal instrumentation surgery was carried out. RESULTS: Primary closure of the fistula and complete bone fusion was achieved after the operation. CONCLUSION: Infection of a Charcot spine, although a rare clinical entity, should be considered as a diagnostic possibility in the spinal cord-injured patients. External spinal fixation is a useful method for the unstable spinal lesion with infection.     

Charcot arthropathy in relation to autonomic dysreflexia in spinal cord injury: case report and review of the literature

Charcot spinal arthropathy has been described as a late complication of spinal cord injury. In patients with these injuries in whom the spine below the level of injury is insensate, joint trauma can progress until spinal instability ensues. The authors describe the case of a 50-year-old man with complete C-8 tetraplegia who experienced a 4-month history of episodic severe headaches, profuse sweating over his face and arms, and episodic severe hypertension in addition to a "grinding" sensation in the lower back. Charcot arthropathy at the T11-12 levels with pathological mobility was demonstrated on neuroimaging. Intraoperatively, a complete spinal cord transection was identified. Anterior and posterior thoracolumbar fusion across the mobile segment resulted in complete amelioration of signs and symptoms of autonomic dysreflexia. This entity, a common condition in the setting of spinal cord injury, has many triggers. Definitive treatment is targeted at the removal of the underlying cause. As demonstrated here, Charcot spinal arthropathy can act as a powerful trigger for induction of autonomic dysreflexia. Treatment of the associated spinal instability resulted in eradication of all signs and symptoms of the dysreflexia.     

Therapie der septischen Querschnittl?hmung

The frequency of infectious diseases of the spine and associated spinal cord injury are constantly increasing. Affected are multimorbid and elderly patients, mostly after prolonged medical treatment. An acute spinal cord injury due to infection is an emergency. A rapid decision for treatment strategy and if at all possible subtle debridement of the infected tissue with decompression of the spinal cord is paramount. Additionally spinal cord injury necessitates specialized treatment and care of the infection. Spinal cord injured patients in general and these patients in particular are prone to complications and need especially trained nursing personnel. It is therefore recommended that patients with vertebral osteomyelitis associated with spinal cord injury should be transferred to dedicated centres of treatment as soon as possible.Just as in cases of spondylodiscitis without spinal cord injury inconsistent surgical or insufficient antibiotic treatment worsens the prognosis significantly. If it is possible to remit the infection, the prognosis for recovery of motor and sensory function is better than in cases with traumatic spinal cord injury. In many cases at least partial recovery can be observed.     

Extensive spinal cord infarction after posterior fossa surgery in the sitting position: case report

OBJECTIVE AND IMPORTANCE: Spinal cord injury is a rare complication of neurosurgery performed with the patient in the sitting position. Previous reports showed that the level of injury is usually located at or near the C5 segmental spinal level, and the term midcervical quadriplegia has been proposed. Extensive spinal cord and lower brainstem infarction also can occur after posterior fossa surgery performed with the patient in the sitting position. CLINICAL PRESENTATION: We describe a 45-year-old woman who was operated on in the sitting position because of a fourth ventricular pilocytic astrocytoma. After surgery, the patient experienced quadriplegia. INTERVENTION: T2-weighted magnetic resonance imaging scans revealed a long, hyperintense area within the cervicothoracic spinal cord that was extended to the lower pons and was consistent with infarction. There was no evidence of previous spine disease. The patient died 6 weeks later of respiratory failure. CONCLUSION: We speculate that alteration of spinal cord blood flow by stretching of the cervical spinal cord and spinal epidural venous engorgement might have caused this devastating complication.     

Late spinal deformity in quadriplegic children and adolescents

Sixty-four quadriplegic children and adolescents were evaluated to determine the benefits of bracing and spinal fusion on the progression and extent of their spinal curves. All those injured before 14 years of age developed a spinal deformity. Bracing in a body jacket assists in maintaining sitting balance and posture and also helps to minimize complications of quadriplegia such as pressure sores. Bracing within 6 months of injury, when the spine is still straight, lessens the incidence, extent, and progression of deformity. Spinal fusion and instrumentation are often necessary for progressive curves to maintain sitting balance and preserve existing function.     

颈胸段脊柱骨折的外科治疗

目的：探讨颈胸段脊柱骨折合并脊髓损伤的临床特点以及治疗的效果。方法：1998年1月至2007年1月采用前路减压、植骨、Zephir钛板内固定治疗的颈胸段脊柱脊髓损伤患者38例,男29例,女9例;年龄18～58岁,平均36．4岁。所有患者均表现为颈胸部疼痛伴有颈胸部活动受限,局部压、叩痛。脊髓损伤按照ASIA分级：A级4例,B级13例,C级10例,D级7例,E级4例。结果：全部患者获随访,随访时间1-10年,平均4．5年,均获得骨性融合,融合时间为4-6个月,无螺钉松动、脱落及钢板断裂等并发症发生。神经功能恢复按AISA分级,平均改善3．8个级别。2例术后出现暂时性声音嘶哑,术后3-6个月恢复。7例Homer征患者术后症状消失。结论：颈胸段脊柱骨折并脊髓损伤表现复杂,前路减压、植骨、内固定可获得良好的治疗效果。