胸腰椎转移性肿瘤的手术治疗

目的探讨不同手术方法治疗胸腰椎转移瘤的疗效。方法对25例胸腰椎转移性肿瘤患者,根据术前Tokuhashi评分、肿瘤侵犯的节段、范围和有无神经症状,采取不同的手术方式治疗。术前与术后均对患者的疼痛、脊髓功能进行评估。结果 25例均获得随访,时间5～60个月。患者术后疼痛均较术前减轻或消失,VAS评分:术前平均为(7.2±2.1)分,术后1个月为(2.4±1.5)分,差异有统计学意义(P<0.05)。16例脊髓损伤的患者术后3个月脊髓功能Frankel分级评估:14例分别提高1～2级,2例无改善。骨水泥渗漏6例,未引起临床症状。随访期内未出现骨水泥下沉、松动、椎体塌陷及成角畸。1例术后1年出现原位复发,行二次手术。8例术后6～12个月出现其它节段椎体转移,均带瘤生存,无神经受损症状,未行外科治疗。结论根据患者术前Tokuhashi评分、肿瘤侵犯的节段、范围和有无神经症状采取不同的手术方法治疗,能稳定和重建脊柱稳定性,减轻或缓解疼痛,维持和改善神经功能,从而提高患者生存质量。     

开放微波消融联合椎体成形和钉棒系统内固定治疗胸腰椎转移瘤

目的:探讨开放微波消融联合椎体成形、钉棒系统内固定在胸腰椎转移性肿瘤治疗中的初步临床效果。方法:对2014年1月至2016年1月收治的12例胸腰椎转移癌行开放微波消融联合椎体成形、钉棒系统内固定治疗的患者进行回顾性分析,其中男6例,女6例;年龄30～75岁,平均55.6岁。转移癌类型:肺转移癌5例,乳腺转移癌2例,甲状腺转移癌2例,肾转移癌2例,肝转移癌1例。转移部位:胸椎转移癌7例,腰椎转移癌5例。Tomita预后评分主要集中在3～6分。脊髓神经功能按ASIA分级:C级3例,D级1例,E级8例。术前的VAS评分为8.3±0.4,术后1、3、6个月以及末次随访时采用视觉模拟评分(visual analogue scale,VAS)评价临床效果。结果:12例患者手术出血量500～2 050 ml,平均850 ml。手术时间3.5～5.5 h,平均4.5 h。术中无神经损伤病例。术后发生脑脊液漏3例,经保守治疗后自愈。切口浅表感染2例,经换药后愈合。肺部感染1例。无深部感染、下肢血栓等并发症。术后12例患者均获得随访,时间9～40个月,平均28.6个月。临床症状均有明显改善,下肢运动功能不同程度的恢复,ASIA分级2例C级恢复至D级,1例C级恢复不明显,1例D级恢复至E级。1例患者术后10个月死于原发性肝癌。随访期间1例患者局部肿瘤复发。术后第1、3、6个月以及末次随访时VAS评分分别为2.7±0.6、2.5±0.4、2.6±0.5、2.5±0.5,与术前比较明显改善(P0.05)。结论:开放微波消融联合椎体成形、钉棒系统内固定治疗胸腰椎转移瘤效果肯定,术中出血量较少、手术时间较短、术后疼痛缓解明显、肿瘤复发率低。     

全脊椎切除术与分离术治疗胸腰椎孤立性转移肿瘤的疗效比较

目的比较全脊椎切除术与分离术治疗胸腰椎孤立性转移肿瘤的临床疗效。方法回顾性分析自2012-07—2017-08诊治的55例胸腰椎孤立性转移瘤,29例采用全脊椎切除术治疗(切除组),26例采用分离手术治疗(分离组),比较2组手术时间、术中出血量、并发症情况、复发胸腰椎转移瘤数、术后生存时间以及末次随访时疼痛VAS评分、Frankel神经功能等级。结果 2组均顺利完成手术并获得完整随访,随访时间5～37个月,平均22.5个月。分离组手术时间较切除组少,差异有统计学意义(P0.05)。2组术中出血量比较差异无统计学意义(P0.05)。切除组术后并发症、复发胸腰椎转移瘤数较分离组少,生存时间较分离组长,差异有统计学意义(P0.05)。末次随访时2组疼痛VAS评分、Frankel神经功能等级比较差异无统计学意义(P0.05)。结论全脊椎切除术与分离术治疗胸腰椎孤立性转移肿瘤可改善患者疼痛、神经功能症状,全脊椎切除术在减少局部复发胸腰椎转移瘤、提高患者生存时间方面具有一定优势。     

胸腰椎转移瘤后路减压固定联合病椎骨水泥成形的短期疗效

目的探讨后路姑息性椎板减压椎弓根螺钉内固定联合病变椎体骨水泥成形术治疗胸腰椎转移瘤的临床疗效。方法回顾性分析2017年8月至2019年12月我院收治的胸腰椎转移瘤致胸腰背部疼痛、双下肢出现神经压迫症状的患者21例,其中男9例,女12例;年龄45～76岁,平均(58.8±7.84)岁。所有患者采用经后路姑息性肿瘤切除、椎管减压,椎弓根螺钉内固定系统重建脊柱序列稳定,病变椎体经椎弓根注入骨水泥。评价术前1 d、术后1周及末次随访时疼痛视觉模拟评分(visual analogue scale, VAS)及Oswestry功能障碍指数(Oswestry disability index, ODI),评估患者胸腰背部疼痛及生活质量改善情况。结果所有21例患者均顺利完成手术,肿瘤病变椎体强化过程中发生骨水泥渗漏7例,无放热效应及毒性反应引起的并发症。所有患者均获得随访,随访时间为6～12个月,平均(9.0±1.5)个月。术后胸腰背部疼痛明显缓解,VAS由术前(8.40±1.28)分下降至术后1周(2.52±0.60)分,末次随访时为(2.86±1.04)分;ODI由术前(69.43±7.45)%下降至术后1周(24.16±4.41)%,末次随访时为(26.48±5.22)%。术后胸腰背痛VAS、ODI与术前相比明显改善,差异均有统计学意义(P0.05)。无内固定松动、断裂或拔出,骨水泥无移位。肿瘤局部复发4例,其中1例术后8个月随访时Frankel分级为B级,未再次手术;另外3例有神经根压迫症状,继续行局部放疗或化疗。结论后路姑息性椎板减压椎弓根螺钉内固定联合病变椎体骨水泥成形术,能明显缓解晚期胸腰椎转移瘤患者疼痛症状,改善功能,提高生活质量,该术式可获得满意的短期疗效。     

“分离手术”在脊柱转移瘤硬膜外脊髓压迫症治疗中的应用及疗效观察

目的探讨"分离手术"在脊柱转移瘤硬膜外脊髓压迫症治疗中的安全性及有效性。方法回顾分析自2014-04—2018-11采用后路环形减压、病椎骨水泥强化、长节段椎弓根钉内固定的"分离手术"治疗的21例脊柱转移瘤硬膜外脊髓压迫症,记录手术时间、术中出血量以及术后生存、并发症、神经功能改善情况,比较术前及术后3 d疼痛VAS评分。结果 21例手术均顺利完成,手术时间160~370 min,平均223.3 min;术中出血量200~2 000 mL,平均557.1 mL。随访期间13例患者去世,生存时间1~21个月,中位生存时间15个月。未出现内固定松动、断裂等相关并发症。术后1例出现术区血肿压迫脊髓,1例于术后3 d出现自发性蛛网膜下腔出血而昏迷;2例出现切口感染,1例上胸段转移瘤术后出现切口积液,1例于术后6个月出现更高节段的硬膜外脊髓压迫症状而放弃进一步治疗。术后3 d疼痛VAS评分较术前明显降低,差异有统计学意义(P<0.05)。术后1例神经功能Frankel A级患者无明显变化;3例B级中1例恢复到C级,2例无变化;10例C级中8例恢复到D级,1例恢复到E级,1例无明显变化;7例D级中5例恢复到E级,2例无明显变化。结论 "分离手术"治疗脊柱转移瘤硬膜外脊髓压迫症安全有效,可有效缓解患者疼痛,改善神经功能等级,值得进一步在临床中推广。     

经皮椎体成形术与开放性手术治疗脊柱转移瘤

【摘要】 目的：探讨经皮椎体成形术（PVP）与开放手术治疗脊柱转移瘤的手术适应证、临床疗效、并发症及外科治疗方式的选择。方法：2004年4月～2011年4月行手术治疗并获得随访的脊柱转移瘤患者共177例,根据手术方法不同分为两组,对原发瘤切除后的孤立转移者,或肿瘤进入椎管压迫脊髓、神经根者,以及脊柱严重不稳者行开放性手术治疗,共87例;对无明显脊髓或神经根受压者,不适宜开放手术者行经皮椎体成形术治疗,共90例。采用VAS评分、ECOG评分、Frankel分级对两组患者的疼痛、功能状况和脊髓功能进行评价;使用Kaplan-Meier法评估两组患者生存率。结果：PVP组共治疗242个椎体,基本无出血,中位手术时间70min;术后2d时VAS评分即有显著降低,并持续至术后1、3、6个月;ECOG评分在术后1周和3个月时均有显著降低;除了无症状的骨水泥渗漏（91/242）外,未发生神经损伤或肺栓塞等严重并发症;中位生存时间为16个月。开放手术组中位手术时间240min,中位出血量1600ml;术后1个月时VAS评分显著降低,并持续至术后3、6个月;ECOG评分在术后1个月和3个月均有显著降低;术前47例有脊髓功能障碍患者中有39例术后Frankel分级得到提高（83%）;29%运动功能完全丧失患者（4/14）和60%运动功能不完全丧失患者（20/33）的神经功能完全恢复;术后17例出现并发症（19.5%）,并发症发生率高,围手术期死亡3例（3.4%）;中位生存时间为11个月。结论：经皮椎体成形术对于椎体转移瘤所导致的疼痛和轻中度不稳定是一种安全有效的微创治疗,应作为一线的姑息治疗方法;开放手术应限于原发瘤切除后的孤立转移有硬膜压迫或严重脊柱不稳定的患者。     

肿瘤姑息切除结合骨水泥强化治疗多发性胸腰椎转移性肿瘤的一年期临床观察

【摘要】〓目的〓探讨对于已经出现脊髓或神经根压迫的多发性胸腰椎转移瘤手术治疗的方法和效果。方法〓采用回顾性研究,对2013~2015年本院收治有完整随访资料的19例多发性胸腰椎转移瘤并出现神经功能受损手术患者,采用后路肿瘤姑息切除椎弓根螺钉固定结合骨水泥充填椎体强化治疗,术后随访1年期内,定期观察术后患者生存质量(包括疼痛、睡眠、食欲)改善程度和神经功能恢复程度。结果〓全组19例患者术后生存质量(疼痛、食欲、睡眠)获得显著改善(与术前比较P<0.01),术后三月约78.9%的患者神经功能获得至少Frankel 1级以上恢复。脊椎稳定性得到加强,在1年随访期内未见内固定松动移位。1例患者在随访期内死亡,2例患者出现局部复发(10.53%)。结论〓对于已经出现脊髓或神经根压迫的多发性胸腰椎转移瘤患者,肿瘤姑息切除结合骨水泥注射强化治疗可以在近期内有效改善晚期肿瘤患者神经功能恢复以及提高患者的生存质量。     

经皮椎体成形术与开放性椎体成形术治疗脊柱转移瘤

目的:探讨经皮椎体成形术与开放性椎体成形术在脊柱转移瘤治疗中的临床应用。方法 :对2012年1月至2016年3月行手术并获得随访的126例脊柱转移性肿瘤患者进行回顾性分析,126例患者依据手术方式不同分为两组,转移性肿瘤进入椎管压迫脊髓、神经根的患者,行开放性手术治疗(开放手术组,43例);无明显脊髓或神经根受压,或不适宜开放手术者行经皮椎体成形术治疗(PVP组,83例)。采用VAS评分、ECOG分级、Frankel分级分别对患者的疼痛、功能状况和脊髓功能进行评价;出院后每3个月门诊随访1次,行X线、CT或MRI检查,每次随访均进行疼痛、神经功能和活动能力的评估。结果:PVP组治疗112个椎体,基本无出血,中位手术时间50 min;术后2 d时VAS评分即有显著降低,并持续至术后1个月;ECOG分级在术后1个月时有显著降低;除了无症状的骨水泥渗漏(44/112)外,未发生神经损伤或肺栓塞等严重并发症;中位生存时间为16个月。开放手术组中位手术时间160 min,中位出血量1 000 ml;术后1个月时VAS评分显著降低;ECOG分级在术后1个月有显著降低;术前41例有脊髓功能障碍患者中有36例术后Frankel分级得到提高(87.8%);40例运动功能不完全丧失患者中有29例完全恢复(76.3%)。术后12例出现并发症(27.9%),中位生存时间为11个月。结论 :对脊柱转移瘤患者选择合适方式的椎体成形术可以有效重建脊柱稳定性,减轻疼痛,提高患者的生活质量。     

后路病灶切除、360°环脊髓减压、钛网骨水泥重建内固定治疗胸腰椎转移性肿瘤

目的探讨一期后路病灶切除、360°环脊髓减压、钛网骨水泥重建内固定治疗胸腰椎转移性肿瘤的临床疗效。方法回顾性分析2011-07-2015-03经上述方法治疗的15例胸腰椎转移瘤临床资料。均行一期后路病灶切除、360°环脊髓减压、钛网骨水泥重建内固定术。观察并记录手术时间、术中失血、术后并发症、生存时间;采用VAS评分、SF-36评分、ASIA分级对患者的疼痛程度、生活质量和神经功能进行评价。结果本组患者平均手术时间(297.2±79.1)min,术中出血量(889.3±368.1)ml。术前、术后1个月、末次随访的VAS评分分别为(7.1±1.2)分、(2.1±1.0)分、(2.9±1.5)分,术后各时间点与术前比较,均具有统计学差异(P0.05)。术前神经功能ASIA分级D级2例,E级13例,末次随访E级12例,D级1例,B级2例。健康调查简表(the MOS item short from health survey,SF-36)评分术前(63.1±7.7)分,术后6个月或末次随访(生存期未达6个月者)(79.8±11.4)分,与术前比较,差异有统计学意义(P0.05)。患者中位生存时间15个月,围术期死亡1例,术后6个月内死亡3例,术后1年内死亡6例,术后2年内死亡9例,存活2年以上1例。至末次随访,共6例患者存活。结论一期后路病灶切除、360°环脊髓减压、钛网骨水泥重建联合内固定治疗胸腰椎转移性肿瘤,可明显改善患者神经症状和生存质量,同时,可为患者争取获得更多辅助治疗的机会,达到局部病变的中长期控制。     

颈胸段脊柱转移瘤的手术疗效及生存率

[目的]探讨颈胸段脊柱(CTJS)转移瘤的手术疗效、生存情况以及影响转移瘤预后的相关因素。[方法]回顾北京大学第三医院2011年1月～2014年12月收治的CTJS转移瘤患者30例。共采用两种手术方式:12例肿瘤切除术;18例姑息性手术。采用VAS评分、ECOG评分、Frankel分级对疼痛、功能状况和脊髓功能进行评价,采用Kaplan-Meier法评估生存时间。对影响转移瘤预后的多种因素进行COX比例风险模型生存分析。[结果]肿瘤切除组手术时间显著长于姑息性手术组[(317.23±61.87) min vs(190.36±38.31) min,P0.05];肿瘤切除组术中出血量显著多于姑息性手术组[(1 691.77±411.92) ml vs(1 011.13±223.68) ml,P0.05]。两组患者术后的VAS评分、ECOG评分均有改善(P0.05);26例术前脊髓功能障碍者,术后21例(80.77%) Frankel分级获得改善至少一个等级。肿瘤切除组中位生存时间21.00个月,1年生存率66.67%;其中5例原发肿瘤恶性程度中-低度、脊柱孤立性转移的患者术后中位生存期44.00个月。相比之下,姑息性手术组中位生存时间15.50个月,1年生存率55.56%(P0.05)。多因素COX比例风险模型生存分析结果显示原发肿瘤恶性程度和内脏转移情况影响患者的生存(P0.05)。[结论]原发肿瘤恶性程度和内脏转移情况影响转移瘤患者的生存。对原发肿瘤恶性程度为中-低度、局部控制好的脊柱孤立性转移瘤行肿瘤切除临床效果满意。     

Morphometric effects of acute shortening of the spine: the kinking and the sliding of the cord,response of the spinal nerves

Spinal shortening is performed for a wide spectrum of diseases. This study was designed to investigate the morphologic effects of shortening on the spinal cord, to enlighten the amount and direction of the sliding of the cord, the alteration of the angles of the roots, and to identify the appropriate laminectomy length. Total vertebrectomy of T12 was applied to ten sheep models after spinal instrumentation. Gradual shortening was applied to five sheep; then, the degree and direction of the sliding of the spinal cord and the angles of the adjacent roots were measured. On five other sheep, additional sagittal sectioning was performed via excision of the pedicles. Measurements were taken at different laminectomy lengths to record kinking of the spinal cord with gradual shortening. The mean sliding of the spinal cord was 9 mm cranially and 7.8 mm caudally. T11 spinal nerves became more vertical caudally, and T12 spinal nerves achieved an ascending position with gradual shortening. Both T11 and T12 spinal nerves were sharply bent in the foramen and on the pedicle of T13, respectively. In full-length shortening, the mean kink of the spine in the sagittal plane was 92.4° for two levels of hemi-laminectomies, 24.6° for complete laminectomy of T11 with hemilaminectomy of T13, and 20.2° for two levels of complete laminectomies. The slippage of the cord is dominant in the earlier stages and kinking is dominant in later stages of shortening. Increasing the laminectomy length by only a half or one level prevents excessive kinking and compressions at the upper and lower margins of the laminectomy. In the later stages of shortening, the spinal nerves near the vertebrectomy site are at risk because of the sharp bending of the nerves. This study describes the mechanism of the sliding and kinking of the cord due to gradual shortening of the spine, which might be useful in spinal surgery procedures. It also states that it is possible to avoid excessive kinking by planning the appropriate technique of laminectomy style in full-length shortening. This study has been approved by Institutional Review Board by sentence number 1150 on 26 April 2006.     

Post operative infections of the spine: technique,indications and results of the surgical treatment - A retrospective study of 90 cases

Post operative infection in spine surgery is a well known complication. The authors studied a series of 90 patients in accordance with an homogenous strategy based on the excision of necrotic and infected tissues, associated with appropriate antibiotics.The results are analyzed according to the degree of infection (which is based on the type of germs and their associations), and type of patients, the delay in diagnosis and the anatomical extension of the infected lesions.Making a difference between superficial and deep infection is of no therapeutic value and may lead to wrong and inadequate treatment.One must separate the common infections (which are due to germs as staphylococcus aureus or others from the urinary or digestive tract), and severe infections (which are either due to a per operative massive and deep contamination, or associated with patient's poor general condition).This series is mainly about posterior approaches to the spine, with or without osteosynthesis. Technical problems for treatment depend on the site of infection, particularly at the thoracic kyphosis level, or at the lumbar level where the muscle necrosis can be extensive. At the cervical level, the infection of an anterior approach mandates a check on the respiratory and digestive tracts.Removing the osteosynthesis is not mandatory in post operative spinal infections, as it may induce severe mechanical destabilization. An anterior approach is not necessarily required in the case of a posterior infection, except with massive contamination of an anterior graft. In some cases, posterior lumbar interbody fusion can lead to the indication for anterior cage removal.Pseudarthrosis of an infected spine, initially treated to obtain fusion, is still the worst complication. In case of previous posterior infection, even a severe one, fusion can still be obtained through a secondary anterior or posterior approach for grafting, with or without osteosynthesis.In this series, there was no neurological complication due to infection.However, eight diceases occured in weak patients with neurological involvement. This points out the importance of the general treatment associated with the surgery, and the necessity of a thorough assessment. a thorough assessment.Résumé Les infections post-opératoires représentent une complication largement documentée dans le domaine de la chirurgie du rachis. Les auteurs étudient une série de 90 patients traités selon une stratégie homogène basée sur l'excision des tissus nécrosés et infectés associée à l'utilisation d'un traitement antibiotique adapté. Les résultats sont analysés en fonction du degré d'infection (basé sur le type de germe et leurs associations) de l'état des patients, du délai pour le diagnostic et de l'étendue anatomique des lésions infectieuses. L'opposition entre infection superficielle et profonde semble sans intérêt sur le plan thérapeutique et peut conduire à un traitement insuffisant ou mal adapté.Il est important de séparer les infections classiques (qui sont dûes à des germes comme le staphylocoque doré ou d'autres germes provenant de la sphère urinaire ou digestive) et les infections sévères (qui sont soit dûes à une contamination per-opératoire massive et profonde ou associées à des patients dont létat général est déficient).Cette série est principalement basée sur les abord postérieurs du rachis avec ou sans ostéosynthèse. Les problèmes techniques pour le traitement dépendent du site de l'infection: aux niveaux thoracique et lombaire, la nécrose musculaire peut être très extensive. Au niveau cervical, l'infection d'un abord antérieur impose de vérifier l'intégrité du tractus aéro-digestif.L'ablation initiale du matériel n'est pas nécessaire dans beaucoup de cas d'infections post-opératoires car elle peut induire des destabilisations sévères et des complications mécaniques supplémentaires. Un abord antérieur n'est pas forcément nécessaire en cas d'infection postérieure mises à part les contaminations massives d'une greffe antérieure ou une infection d'une cage intervertébrale réalisée pour une fusion intersomatique par voie postérieure.La pseudarthrose des greffes sur un rachis infecté qui a été traité initialement pour obtenir une fusion reste encore la plus sévère des complications. Dans les cas d'infections postérieures même sévères, la fusion peut être encore obtenue secondairement grâce à un abord antérieur ultérieur ou même un abord postérieur pour des greffes complémentaires avec ou sans ostéosynthèse.Dans cette série, les auteurs ne signalent aucune complication neurologique dûe à l'infection. Néanmoins, 8 décès sont à déplorer chez des patients fragiles avec signes neurologiques initiaux. Ceci souligne l'importance du traitement général associé à la chirurgie et la nécessité d'un bilan complet de ces malades.EBJIS Congress, Leuven     

Experimental determination of the effect of progressive sharp-angle spinal deformity on the spinal cord

Neurological deficit is a serious though not well-known complication associated with spinal deformity. Sharp-angle kyphosis may be congenital, traumatic, degenerative, infectious, or iatrogenic in origin. Many kyphotic deformities are underestimated, thus leading to severe neurological deficit. In order to determine exactly what procedures of angulation the patients should undergo to stabilize the spine, which are major operations, the authors analyzed in an experimental model the effects of progressive sharp angulation on the anatomy of spinal canal and cord. We found that sharp anterior angulation of 50° causes ante rior-posterior stenosis and the dura will touch the spinal cord. At 90° of angulation, the spinal cord will be squeezed and the pressure in the canal will be double what it was initially, probably leading to ischemia. The experimental confirmation (determination) of these angulations allows the physician in charge to define early in the treatment program when a surgical stabilization procedure should be included, before the angulation causes any neurological damage.     

胸腰椎骨折伴脊髓损伤治疗进展

脊柱骨折伴脊髓损伤的治疗，一直是脊柱外科关注的课题，随着对神经损伤的病理生理研究深入和手术方法的改进，对其治疗方法和观点也有了进一步的发展。本文就胸腰椎骨折伴脊髓损伤治疗方面的进展进行综述。     

创伤性上升性脊髓缺血损伤

脊椎损伤后,脊髓损伤平面上升较为少见。作者报告了５例,其中Ｔ１０－１１骨折脱位２例：１例于伤后２周内,截竣平面上升至Ｃ２,呼吸麻痹死亡,１例上升至颈部脊髓,双上肢无力;另３例为Ｔ１２骨折２例,Ｌ３骨折１例：其中截竣平面上升至Ｔ９至１例,Ｔ８者２例。５例患者双下肢皆呈软竣,１例死亡患者尸检见脊髓完整,Ｔ９－１０段脊髓前后动静脉血栓,其向上至Ｃ３,向下至Ｓ１,脊髓前血管、中央血管、髓内小血管多处 栓,     

Paralysis of the arm after posterior decompression of the cervical spinal cord

Summary Paralysis of the arm with radicular distribution occurring after posterior decompression of the cervical spinal cord included C5, C6, C7 and C8 roots, in isolation or combined. The most frequent patterns of paralysis were C5 and C6 root involvements of the motor-dominant type. The overall frequency of occurrence in our series was 11% (20 cases of postoperative paralysis in 188 surgical cases), but the frequency varied with the posterior decompression method. The higher frequency of postoperative paralysis was noted in the group in which the surgical procedures selected were considered as enabling the expanded dura to exert its traction power more easily on the extradural portion of the roots. Radiographical analyses showed that C5 roots which satisfied the following two conditions were more prone to sustain postoperative paralysis: first, location at the level of the highly expanded dural tube and, second, lying in the foramina with a higher degree of anterior protrusion of the superior process. In the majority of cases with C5 motor-dominant paralysis, the postoperative cord-root pouch distances of the C5 anterior roots were unchanged or even decreased compared with the preoperative ones, but the extradural portions of the C5 roots were elongated in all cases. These findings support the validity of mechanisms of postoperative paralysis which were deduced from the anatomical investigations.     

复杂性腰椎管狭窄症手术方法比较

目的 评估椎板切除后外侧融合术，椎板切除椎间融合经椎弓根内固定术治疗复杂性腰椎管狭窄患者的术后近，中期疗效。方法 有21例患者接受椎板切除后外侧融合术，22例患者接受椎板切除椎间融合椎弓根内固定术，术后进行Oswestry疗效评定和腰椎影像学观察。结果 术后1年疗效优良率后外侧融合组为81.0%。椎间融合固定组为81.8%。术后1年两组疗效优良率无显著差别。术后4年疗效优良率后外侧融合组为72.2%,椎间融合组为78.9%。术后4后外侧融合组疗效下降显著，椎间融合组疗效下降不显著，结论 椎板切除椎间融合经椎弓根内固定术，椎板切除后外侧融合术治疗复杂性腰椎管狭窄症，术后近期疗效均满意，椎板切除后外侧融合组术后中期疗效下降，其腰椎不稳定和腰椎管再狭窄发生率较高。     

单球囊双侧扩张椎体后凸成形术的探讨

目的探讨单球囊双侧扩张椎体后凸成形术治疗老年骨质疏松性脊柱压缩骨折的临床疗效。方法2002年3月～2004年2月,采用单球囊双侧扩张椎体后凸成形术治疗老年骨质疏松性脊柱压缩骨折15例17椎,男6例6椎,女9例11椎;年龄62～83岁,平均70.5岁。T12 8椎,L1 7椎,T8 1椎,T11 1椎。术前CT显示椎体后壁均完整。MRI显示骨折椎体在T1WI呈低信号,T2WI呈高信号。经骨密度仪测定证实脊椎均存在不同程度的骨质疏松,平均骨密度为0.603g/cm2。结果所有患者术后疼痛均明显减轻,疼痛视觉模拟数字评分由术前平均8.3分降至术后平均2.1分。平均椎体前缘高度恢复54.2%±34.1%,中部恢复60.5%±35.4%,后缘恢复40.7%±32.3%。矢状面排列改善明显。手术前后侧位X线片示Cobb角平均改善9.5°(0°～28°)。平均灌注骨水泥5.9ml(3.5～7.8ml)。除1个椎体前缘有少许未引起临床症状的骨水泥渗漏外,其余椎体在X线片上均无明显骨水泥渗漏。所有患者均获得随访,随访时间2～48个月,平均10.5个月,未发现与手术有关的并发症出现。结论单球囊双侧扩张椎体后凸成形术治疗老年骨质疏松性脊柱压缩骨折可以有效缓解疼痛,恢复椎体高度,改善椎体矢状面排列,疗效满意。     

Experimental study on the effect of slowly progressive chronic compression on the spinal cord

Summary Experimentally produced rapid and slowly progressive compression of the cervical spinal cord in cats demonstrated two very different patterns of damage, with disturbance of nerve cells and microvasculature.The spinal cord suffered less damage even from more severe pressure if this was applied slowly.The histological and microangiographic results provide confirmation of phenomena observed clinically.

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Résumé La réalisation expérimentale, chez le chat, de compression rapide ou lentement progressive de la moelle cervicale met en évidence deux types très différents de lésions, avec altération des cellules nerveuses et de la microvascularisation.La moelle est moins lésée, même si la compression est plus importante, lorsque celle-ci est appliquée progressivement.Les constatations histologiques et microangiographiques apportent la confirmation des phénomènes observés en clinique.

     

Spinal extradural angiolipoma: report of two cases and review of the literature

Spinal angiolipomas are benign uncommon neoplasm composed of mature lipocytes admixed with abnormal blood vessels. They account for only 0.04–1.2% of all spinal tumors. We report two cases of lumbar extradural angiolipoma and review previously reported cases. We found 118 cases of spinal epidural angiolipoma (70 females and 48 males; age range 1.5–85 years, mean 44.03) spanning from 1890 to 2006. Prior to diagnosis 40.6% of the patients had weakness of the lower limbs. The interval between the initial symptoms and tumor diagnosis ranged from 1 day to 17 years (mean 20.2 months). Except for four cases diagnosed at autopsy, 109 patients underwent surgery and gross-total resection was performed in 79 cases (72.4%). Spinal angiolipomas are tumors containing angiomatous and lipomatous tissue, predominantly located in the mid-thoracic region. All angiolipomas show iso- or hyperintensity on T1-weighted images and hyperintensity on T2-weighted images and most lesions enhance with gadolinium administration. The treatment for spinal extradural angiolipomas is total surgical resection and no adjuvant therapy should be administered.