应用PEEK材料cage颈前路减压椎间融合术治疗脊髓型颈椎病的疗效观察

目的：观察分析应用PEEK材料椎间融合器颈前路减压椎间融合术治疗脊髓型颈椎病的疗效.方法：应用PEEK材料椎间融合器颈前路减压椎间融合术治疗脊髓型颈椎病39例83节段,其中单节段6例,双节段22例,三节段11例.手术前后应用JOA评分评定手术效果.结果：术后随访36.1（10～50）个月,JOA评分术前为平均（8.9±1.4）分,术后末次随访时为（14.3±2.4）分,平均改善率为（66.3%±5.4%）,与术前比较差异有统计学意义（P ＜0.01）,优良率为76.9%.颈椎生理曲度、融合节段高度均恢复,以三节段者为佳.椎间融合率术后6、12个月分别为89.7%、100%.无并发症发生.结论：应用PEEK材料椎间融合器颈前路减压椎间融合术治疗脊髓型颈椎病的疗效可靠,能够提高和维持颈椎曲度和融合节段高度.     

保留C_2棘突止点全椎板减压侧块螺钉固定术治疗累及C_2节段的脊髓型颈椎病疗效观察

目的观察保留C_2棘突止点全椎板切除侧块螺钉固定术在治疗累及C_2水平的脊髓型颈椎病临床疗效。方法选取2014年3月～2016年12月共26例在我院接受手术的累及C_2水平的多节段脊髓型颈椎病患者,均采用保留C_2棘突止点的潜行减压+全椎板切除减压侧块螺钉固定术治疗。观察患者神经功能恢复、颈椎曲度改变、轴性症状及C_5神经根麻痹发生情况。结果所有患者均顺利接受手术,手术时间(141.7±36.2)min,术中出血量(328.1±43.9)mL;椎板切除宽度(17.1±2.2)mm,JOA评分由术前的(7.4±2.3)分恢复为术后3个月时的(12.3±3.1)分及末次随访时的(13.5±3.3)分,不同时间点比较具有统计学意义(0.05),末次随访时神经功能改善率达到(63.7±12.5)%。颈椎曲度指数由术前的(13.6±3.7)%,增加到术后3个月时的(16.8±4.3)%及末次随访时为(16.2±4.2)%,手术前后比较具有显著统计学差异(0.05)。术后出现C_5神经根麻痹患者2例,发生率为7.7%(2/26)。根据轴性症状评定标准:优14例,良8例,可2例,差2例,AS发生率15.4%。结论保留C_2棘突止点全椎板减压侧块螺钉固定术是治疗累及C_2水平脊髓型颈椎病的一种有效术式,能够解除脊髓压迫并促进神经功能显著恢复,侧块螺钉植入可避免颈椎后凸畸形,同时可降低轴性症状及C_5神经根麻痹的发生。     

单嵌片自稳型颈椎融合器在颈椎前路减压融合术中的应用#br#

目的　探讨单嵌片自稳型颈椎融合器在颈椎前路减压融合术中的应用,报告5年随访疗效。 方法 　选取47例因脊髓型或神经根型颈椎病行颈椎前路减压+单嵌片自稳型颈椎融合器置入术患者。侧位X线片观察椎间高度、颈椎前凸角及植骨融合率;术前及术后进行JOA评分,观察神经功能恢复情况;VAS评分评价患者颈部或肢体疼痛;SF-36健康调查评分观察临床疗效。 结果　术后6个月67个融合节段均获骨性融合。椎间隙高度术前为（4.47±0.86）mm,末次随访为（7.41±0.72）mm。颈椎前凸角术前为（0.7±4.1）°,末次随访为（5.9±3.6）°。随访56~96个月,所有患者未出现严重手术并发症,神经功能有明显恢复。JOA评分由术前（9.15 ±0.22）分增至末次随访（14.89±0.16）分,VAS评分由术前（5.24±1.44）分减至末次随访（0.35±0.49）分。JOA及VAS评分术前较术后各次随访具有统计学差异（P<0.05),但术后各次随访之间无统计学差异（P>0.05）。SF-36健康调查评分6个维度,术前及术后评分均具有统计学差异（P<0.05）。 结论　单嵌片自稳型颈椎融合器能使融合节段获得即刻稳定性,有效恢复和维持椎间隙高度,植骨融合率高,中远期疗效好,适用于多种需前路减压的颈椎退变性疾病。     

单嵌片自稳型颈椎融合器在颈椎前路减压融合术中的应用

目的探讨单嵌片自稳型颈椎融合器在颈椎前路减压融合术中的应用,报告5年随访疗效。方法选取47例因脊髓型或神经根型颈椎病行颈椎前路减压+单嵌片自稳型颈椎融合器置入术患者。侧位X线片观察椎间高度、颈椎前凸角及植骨融合率;术前及术后进行JOA评分,观察神经功能恢复情况;VAS评分评价患者颈部或肢体疼痛;SF-36健康调查评分观察临床疗效。结果术后6个月67个融合节段均获骨性融合。椎间隙高度术前为(4.47±0.86)mm,末次随访为(7.41±0.72)mm。颈椎前凸角术前为(0.7±4.1)°,末次随访为(5.9±3.6)°。随访56～96个月,所有患者未出现严重手术并发症,神经功能有明显恢复。JOA评分由术前(9.15±0.22)分增至末次随访(14.89±0.16)分,VAS评分由术前(5.24±1.44)分减至末次随访(0.35±0.49)分。JOA及VAS评分术前较术后各次随访具有统计学差异(P0.05),但术后各次随访之间无统计学差异(P0.05)。SF-36健康调查评分6个维度,术前及术后评分均具有统计学差异(P0.05)。结论单嵌片自稳型颈椎融合器能使融合节段获得即刻稳定性,有效恢复和维持椎间隙高度,植骨融合率高,中远期疗效好,适用于多种需前路减压的颈椎退变性疾病。     

零切迹椎间融合固定器与传统颈前路钢板Cage融合内固定治疗双节段颈椎病的比较

文题释义： 零切迹椎间融合固定器：放入椎间隙内的融合器带斜向螺钉孔,通过孔置入螺钉可固定相邻椎体,且螺钉尾部沉入融合器内,椎体前方无内植物外露。 传统颈椎前路钢板及Cage：前路行手术治疗减压患者椎间隙后,处理上下终板,于椎间隙内放入预填充骨块的Cage,于椎体前方安放钢板螺钉固定相邻椎体。 背景：颈前路减压植骨融合是治疗颈椎病的一种经典手术方式,目前可选择零切迹椎间融合固定器与传统颈前路钢板、Cage作为内固定融合材料。与传统颈前路钢板固定系统相比,零切迹椎间融合固定器具有术后对食管干扰小、降低术后吞咽困难发生率、避免钢板过长或位置不佳损伤临近节段椎间盘等优势。 目的：比较零切迹椎间融合固定器Zero-P与传统颈前路钢板Cage融合内固定治疗双节段颈椎病的安全性和有效性。 方法：回顾性分析成都市第三人民医院2016年5月至2018年5月行颈椎前路减压植骨治疗的60例双节段颈椎病患者的临床资料,根据融合方式分为2组,Zero-P组采用Zero-P融合固定,钢板组采用颈椎前路钢板固定联合Cage置入,每组30例。2组患者对治疗方案均知情同意,且得到医院伦理委员会批准。采用日本骨科学会评分、颈部功能障碍指数、Bazaz吞咽功能评分评估临床疗效;行颈椎X射线、颈椎CT检查,测量颈椎曲度,观察植骨融合情况以及内植物移位、松动及断裂等并发症发生情况。 结果与结论：①60例患者均顺利完成手术,术后伤口均Ⅰ期愈合,无神经损伤、食管瘘、脑脊液漏等严重并发症发生;②在术后随访中,2组患者颈部功能障碍指数及日本骨科学会评分、植骨融合率差异均无显著性意义(P > 0.05);③Zero-P组患者吞咽困难发生率和严重程度在术后各随访时间点均低于钢板组(P均< 0.05);④术后6个月及末次随访,钢板组患者在颈椎整体曲度和手术节段曲度方面均优于Zero-P(P < 0.05);⑤提示双节段Zero-P椎间融合是一种安全有效的治疗方式,在手术时间、出血量、透视次数、术后吞咽困难发生率方面均优于传统颈椎前路钢板固定系统,但在颈椎曲度方面不如传统颈前路钢板系统。术前颈椎曲度明显异常的患者不推荐使用Zero-P椎间融合固定器作为内固定器械。 ORCID: 0000-0003-3584-5276(余彬) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

脊柱显微内镜下前路颈椎间盘切除植骨融合钢板内固定治疗颈椎病

目的 观察脊柱显微内镜经前路椎间减压椎间融植骨融合治疗颈椎病的临床疗效.方法 自2006年6月～2011年6月共治疗单节段颈椎病患者31例.男15例,女16例,年龄36～78岁,平均49岁.患者术前表现不同程度的一侧肢体疼痛、麻木或乏力.31例患者均进行脊柱显微内镜下前路颈椎间盘切除减压、自体骨椎间植骨融合.主要观察指标:依据JOA评分系统评价患者神经症状的改善程度,手术后影像资料,含颈椎生理曲度、椎间隙融合情况等.结果 所有患者均获得随访,随访时间3～36个月,平均18个月,31例患者均在脊柱显微内镜下顺利完成椎间植骨融合术,并行短节段颈椎前路钢板固定手术,手术时间80～225分钟,平均102±34分钟,手术出血40～180ml,平均80±30ml,术后住院时间6～10天,平均7天.手术后患者神经功能均有不同程度改善,按JOA脊髓功能评分:术前JOA评分为4～10分,平均7.4±0.12分,术后8～16分,平均13.8±0.17分,平均改善率13.8-7.4)/(17-7.4)×100%= 66.6%.治疗前后比较,差异有显著性(P<0.01).融合节段间棘突过伸过屈距离改变:术前3.4±0.3cm,术后3月2.5±0.24cm,术后6月1.9±0.18cm,治疗前后差别有显著统计意义(P<0.01),全部病例均达到椎间隙融合,融合率100%.1例术后C5左侧神经根支配区域麻痛,术后3周逐步减轻.未发生神经损伤、硬脊膜破裂、脑脊液漏、椎动脉损伤、术后血肿及感染、钢板螺钉折断、植骨块松动等并发症.结论 脊柱显微内镜下前路颈椎前路减压更精确,椎间隙减压充分,能保留椎体终板结构,对保证手术后颈椎的植骨椎间融合,防止椎间融合后的塌陷有意义,可显著提高手术后的疗效.     

跳跃式颈椎前路减压融合术治疗两节段非连续脊髓型颈椎病的近期疗效

目的评价跳跃式颈椎前路椎间盘切除减压融合术治疗两节段非连续脊髓型颈椎病的近期疗效。方法回顾分析2014年1月至2016年12月我科34例两节段跳跃式脊髓型颈椎病行颈椎前路椎间盘切除减压融合术患者的手术时间、术中出血量、JOA评分、NDI评分、JOA改善率、节段前凸角度、融合率及末次随访的Odom’s临床疗效评定。结果手术时间92~125 min,平均103.28 min;术中失血约50~150 m L,平均90 m L;术后颈椎侧位X射线示颈椎生理弯曲恢复。所有患者均获得随访,平均6个月。末次随访见植骨融合率94.1%,无CAGE下沉、内固定松动脱落、感染等严重并发症发生。末次随访的JOA评分(14.21±0.732)分,NDI评分(3.26±1.14)分;平均改善率58.62%;节段性前凸角度术前(10.75±1.132)°,术后(15.61±1.312)°,差异具有统计学意义(P0.05)。根据末次随访时Odom’s临床疗效评定:优21例,良9例,中4例,优良率为88.2%。结论颈椎前路间盘切除减压融合术治疗跳跃式两节段脊髓型颈椎病,能较好恢复颈椎生理曲度和椎间高度且其融合率高,近期临床疗效满意。     

ZEPHIR颈前路钢板系统治疗外伤性颈椎不稳

目的观察ZEPHIR颈前路钢板系统在外伤性颈椎不稳伴脊髓神经损伤手术中的作用和疗效.方法对21例外伤性颈椎不稳伴脊髓神经损伤患者行颈前路减压植骨、ZEPHIR前路钢板内固定术.术后随访观察神经功能恢复情况.植骨融合率及有无植入物并发症.结果术后随访6～22个月(平均11个月).20例术后症状明显缓解,脊髓神经功能有不同程度改善.术后6个月植骨融合率达到100%,无钢板螺钉松动或断裂,1例术后3个月死亡.结论应用颈前路减压植骨,ZEPHIR颈前路钢板系统内固定术治疗外伤性颈椎不稳伴脊髓神经损伤具有以下优点:颈椎前路减压彻底,术后颈椎即可稳定,防止植骨块移位,提高植骨融合率.     

下颈椎骨折脱位的前路手术治疗

目的:探讨下颈椎骨折脱位前路手术的治疗优点及疗效.方法:对35例下位颈椎骨折脱位采用前路复位,术中不能完全复位者行伤椎椎体次全切除后复位,同时行自体骨植骨和/或钛网、钢板内固定.结果:所有病例均获完全复位,术后神经功能获得不同程度的改善.随访12月～3 a,平均随访14个月,术后1～5月植骨融合(平均3.2月),随访时颈椎椎间高度、生理曲度维持良好,无钢板、螺钉折断、滑脱等并发症.结论:颈前路手术治疗下颈椎骨折脱位,可充分减压、复位、恢复颈椎椎间高度和生理曲度,更重要的是可重建颈椎的即刻稳定性,防止继发性脊髓损伤,有利于神经功能恢复.     

减压椎间植骨融合内固定术与单纯减压术治疗颈椎多节段退变的对比分析

目的分析减压椎间植骨融合内固定术与单纯减压术治疗颈椎多节段退变的临床价值。方法选取2012年至2014年我院收治的颈椎多节段退变患者40例,随机将患者分为2组,20例患者行减压椎间植骨融合内固定术(内固定组),20例单纯减压术(减压组),所有患者完整随访,对比分析2组患者的临床治疗效果。结果术后患者VAS评分和JOA评分显示,内固定组相较于减压组患者评分明显改善,差异具统计学意义(P0.05)。与单纯减压术相比,减压椎间植骨融合内固定术术后颈椎曲度以及手术节段曲度改善明显,尤以术后1年最为明显,差异具有统计学意义(P0.05)。术后1年颈椎关节活动度均较术前有所改善,差异具有统计学意义(P0.05);末次随访2组患者颈椎关节活动度较治疗前差异无统计学意义(P0.05);内固定组相较于减压组治疗颈椎多节段退行性病变术后颈椎活动度改善效果显著,差异具有统计学意义(P0.05)。结论减压椎间植骨融合内固定术治疗颈椎多节段退变临床效果优于单纯减压术,可以满足临床生物力学方面的要求。     

Ultrastructure of the anterior ventral and anterior medial nuclei of the cat thalamus

Summary Electron microscopical studies of the thalamic AV-AM nuclei substantiated the presence of two main types of neurons, i.e. principal (or relay) cells and Golgi type II interneurons. Characteristic synaptic islands are found in abundance in the AV-AM. Four different types of synaptic terminals have been identified in these islands: RL-boutons = large axonal terminals with round synaptic vesicles; RS-boutons = small axonal terminals with round synaptic vesicles; F₁-boutons = small axonal profiles containing flattened synaptic vesicles, and F₂-profiles interpreted as presynaptic dendrite appendages, bearing pleomorphic vesicles, both belonging to the Golgi type II interneurons. — The synaptic relations were studied in normal preparations and after lesions in the mamillary body, limbic cortex and hippocampus. The specific afferents (RL-boutons) — originating from the medial mamillary nucleus — are presynaptic to both relay cell dendrites and presynaptic dendrite profiles of Golgi type II interneurons, which in turn are presynaptic to the same relay dendrites (synaptic triads). RS-boutons originate mainly from limbic cortex and hippocampus.     

Comparison of anterior cruciate ligament volume after anatomic double-bundle anterior cruciate ligament reconstruction

Backgroud

To determine whether anatomic double-bundle anterior cruciate ligament reconstruction (DB-ACLR) can restore the native ACL volume, and whether the volume change after reconstruction affects clinical outcomes and re-rupture rates following the contemporary techniques.

Angiomyolipoma of the anterior mediastinum

Angiomyolipoma is a benign tumor composed of varying proportions of smooth muscle cells, blood vessels, and adipose tissue that most commonly occurs in the kidney. Sporadic lesions and lesions arising in the setting of the tuberous sclerosis complex have been reported in extrarenal sites. We present the case of an incidentally discovered angiomyolipoma in the anterior mediastinum. Thymoma was suspected clinically, and the lesion was composed mainly of spindled-to-epithelioid cells arranged in a histologic pattern reminiscent of hemangiopericytoma, a pattern that has been described in thymoma. Immunohistochemical stains revealed positivity for smooth muscle actin and HMB-45, revealing the expression of smooth muscle and melanocytic markers characteristic of angiomyolipoma and other lesions in the PEComa family.     

Conjoint activity of anterior insular and anterior cingulate cortex: awareness and response

There is now a wealth of evidence that anterior insular and anterior cingulate cortices have a close functional relationship, such that they may be considered together as input and output regions of a functional system. This system is typically engaged across cognitive, affective, and behavioural contexts, suggesting that it is of fundamental importance for mental life. Here, we review the literature and reinforce the case that these brain regions are crucial, firstly, for the production of subjective feelings and, secondly, for co-ordinating appropriate responses to internal and external events. This model seeks to integrate higher-order cortical functions with sensory representation and autonomic control: it is argued that feeling states emerge from the raw data of sensory (including interoceptive) inputs and are integrated through representations in conscious awareness. Correspondingly, autonomic nervous system reactivity is particularly important amongst the responses that accompany conscious experiences. Potential clinical implications are also discussed.     

Gnathostomiasis of the anterior chamber

Ocular involvement with Gnathostoma spinigerum occurs years after the initial infection that is acquired by ingestion of poorly cooked, pickled seafood or water contaminated with third stage larvae. Here we report a case of gnathostomiasis of the left eye of a 32-year-old lady hailing from Meghalaya, India. Her vision had deteriorated to hand movement. Slit lamp examination revealed a live, actively motile worm in the anterior chamber, which was extracted by supra temporal limbal incision and visual acuity was restored.     

Absence of scalenus anterior muscle

A rare anomaly of the scalenus muscles is described. In this case, the right scalenus anterior muscle was absent. As a substitute for this muscle, some aberrant muscle slips arose from the lower vertebrae and descended in front of the ventral rami of the lower cervical nerves. These aberrant slips then ran between the ventral rami of the the eighth cervical and first thoracic nerves, and were fused with the right scalenus medius muscle. Thus, the subclavian artery and vein ran in front of the aberrant slips, together with the ventral ramus of the first thoracic nerve. The aberrant muscle slips issued 2 accessory bundles. One bundle ran between the ventral rami of the fourth and fifth cervical nerves and was fused with the scalenus medius muscle; the other bundle ran between the ventral rami of the fifth and sixth cervical nerves and was fused with the scalenus medius muscle.