颈椎病和颈椎解剖关系的探讨

本文观察了62例颈椎病(神经根型34例、椎动脉型3例,其中推动脉和神经根的混合型18例、椎间盘突出25例)和14具颈椎标本,探讨了颈椎病发病机理和CT表现,CT表现为:(1)钩突骨质增生;(2)椎间孔狭窄;(3)颈椎失稳;(4)椎间盘突出;(5)椎体周缘骨赘和韧带骨化。     

颈椎前外侧入路椎间孔扩大术治疗神经根型和椎动脉型颈椎病的初步临床报告

目的 探讨颈椎前外侧入路手术治疗神经根型和椎动脉型颈椎病的方法及仞步临床结果.方法 6例单侧神经根型颈椎病、2例单纯椎动脉型颈椎病患者,手术前日本整形外科协会(JOA)评分平均15分.均于手术显微镜下施行颈椎前外侧入路钩椎关节切除及椎间孔扩大术.结果 8例患者手术后临床症状即刻缓解.手术后3个月神经根型颈椎病患者CT和(或)MRI检查显示椎间孔减压良好,椎动脉型颈椎病患者CT和(或)CTA检查椎动脉减压良好;动态X线检查手术节段椎体活动度保留.JOA评分平均16.60分.随访6～47个月,无一例复发.结论 颈椎前外侧入路手术可以直视神经根和椎动脉,能够获得最为理想的减压效果,且不破坏椎问盘的完整性,无需椎体间融合及内固定,可以保留椎间盘的功能及椎体间的活动度.     

颈椎病手术治疗的现状

颈椎病是以颈椎退行性变为病理基础的临床病征.颈椎椎间盘组织退行性改变及其继发病理改变累及周围组织结构(神经根、脊髓、椎动脉、交感神经等),出现相应的临床表现,即为颈椎病.椎间盘变性导致颈椎不稳,带来继发改变,如前后纵韧带-椎间盘问隙的出现与血肿形成、钙化、骨化和骨赘形成,钩椎关节及关节突关节增生,黄韧带、前后纵韧带、关节囊、项韧带的松弛、增生、钙化、骨化等.以上病理改变对神经根、脊髓、交感神经、椎动脉、脊髓周围动静脉造成刺激与压迫,从而产生相应的临床表现.颈椎病通常分为颈型、神经根型、脊髓型、椎动脉型、交感神经型与混合型.     

头颈部创伤后颈-脑综合征

头颈部创伤后颈脑综合症,又称外伤性钩椎关节病或外伤性椎动脉型颈椎病[1],是指在头颈部外伤后,由于钩椎关节创伤反应,造成椎动脉痉挛、狭窄或扭曲而引起颅脑症状者.临床易误诊为脑外伤综合征或脑外伤后遗症.我科近3年来收治此类患者30例,报告如下:     

脊髓型颈椎病合并运动神经元病的早期诊断及手术治疗

脊髓型颈椎病(Cervical spondylotic myelopathy,CSM)是由于颈部椎间盘中下段变性导致椎管和椎间孔狭窄而出现脊髓和神经根症状的一种疾病,国内学者多认为颈椎间盘退行性变是疾病发生和发展中最重要的原因和启动因素,另外可能与牵张性损伤及颈椎先天性椎管狭窄有关[1].     

椎动脉横突孔段受压的手术治疗二例

例1 女,45岁。4年前感肩背部酸沉麻木,2年来常感头痛,头晕、转颈过度时头晕加重伴恶心呕吐、视物旋转,偶然出现猝倒。1986年3月入院检查,颈椎正及双斜位X线平片示颈4、5、6双侧钩椎关节骨质增生,左侧为著.椎动脉造影示:左椎动脉于颈4、5、6横突孔之间有受压现象。手术于全麻插管下颈前入路,以颈5为中点沿胸锁乳突肌前缘皮肤切口,将胸锁乳突肌、颈动、静脉牵向外侧,气管、食道牵向对侧,将颈长肌切断分离横突。发现上下横突孔之间椎动脉周围纤维组织增生变硬无弹性,椎动脉内侧壁受钩突关节外侧增生骨质压     

颈椎病椎体次全切除术

介绍采用改良式颈椎椎体次全切除术治疗４７例多节段脊髓型或脊髓－神经根混合型颈椎病。手术有效率为９３．７％（４４例），优良率为８０．９％（３８例），无手术死亡或重残发生。文中讨论了本手术的解剖基础、适应证和作者手术体会。     

颈椎病的分型及临床特点

目的探讨各型颈椎病的临床特点，以便于掌握其临床特征进行合理的鉴别诊断。方法对我院神经内科收入院的150例各型颈椎病患者进行回顾性分析。结果神经根型颈椎病以一侧上肢麻木、疼痛、肌萎缩为主要表现，神经电生理检查厦颈椎MRI有助于诊断；脊髓型颈椎病以缓慢进展性的四肢腱反射亢进、病理征阳性为主要特点，而感觉障碍并不明显；而椎动脉型颈椎病以眩晕为主要表现，头颅MRI有助于鉴别诊断。结论神经根型颈椎病需与脊髓空洞症、进行性脊肌萎缩症鉴别，脊髓型颈椎病的发机制推测可能与脊髓长期慢性缺血有关，椎动脉型颈椎病应重视与进展性后循环梗塞的鉴别诊断。     

前外侧入路治疗颈椎病的应用解剖学研究

目的通过对颈椎C3～C7各项指标的测量,为前外侧入路治疗颈椎病提供解剖学依据。方法测量35例C3～C7干燥标本的横突孔、钩椎关节、椎体和椎管的相关数据。结果①椎体前缘至横突孔前缘距离C3～C6逐渐减小,C3为(8.28±1.70)mm,C6为(7.17±1.15)mm。②横突孔横径一般左侧大于右侧,横突孔横径平均为(5.94±0.48)mm,在C5最小,为(5.35±0.81)mm。③横突孔间距离C3～C7逐渐增加,C3为(23.12±0.93)mm,C7为(31.64±2.28)mm。④钩椎关节间距离C3～C7逐渐增加,C3为(19.09±1.54)mm,C7为(25.02±2.97)mm。⑤钩椎关节至椎间孔内侧缘的距离C7最大,为(4.76±1.49)mm;C5最小,为(3.79±0.73)mm。⑥C3～C7椎体前后径平均值为(15.78±1.64)mm。⑦椎管直径相差不大,平均为13～14mm。结论颈椎前外侧入路是治疗颈椎病的理想术式,研究和熟悉手术入路相关解剖结构对指导手术十分必要。     

高校师生颈椎病X线征象特点分析

目的 分析高校师生颈椎病的X线征象特点及防治重点.方法 收集164例经X线检查诊断为颈椎病的师生的病史、临床症状、生活习惯、颈椎X线征象分析.结果 65名教师的颈椎X线征象中,椎体骨质增生构成比最高占64.6%,其次为钩突增生(58.4%)和椎间隙变窄(53.8%).99名学生的颈椎X线征象中,生理曲度改变占83.8%,椎体骨质增生占22.0%,椎体失稳占21.2%.结论 高校师生是颈椎病高危人群,低枕睡眠、定时工歇等保健措施能减少和延缓颈椎病及并发症的发生.     

颈前路手术治疗颈椎脱位并发椎间盘突出

目的：颈椎脱位常合并发生椎间盘突出，及时发现并实施正确治疗，能避免脊髓二次损伤，提高治疗效果。方法：初治疗的３例先试行闭合牵引复位治疗，２例因合并椎间盘突出，出现神经损伤加重症状。全组１５例经ＭＲＩ检查，发现有９例并发椎间盘突出，随即行颈前路减压，椎体复位及植骨固定手术。结果：神经损伤症状明显改善６例（６６％），无一例症状加重。结论：颈椎屈曲型损伤并发椎间盘突出有较高的发生率，ＭＲＩ检查因其安全性和可靠性，对明确诊断极有意义。此类患者的治疗除复位外，尽早摘除椎间盘去除致压物，使硬脊膜囊充分减压，并行椎体间植骨，保持颈椎稳定性是其治疗关键，而前路手术是最好的选择。     

椎动脉起始位置与穿出颈椎横突孔高度关系的三维CT血管成像研究

目的通过三维CT血管成像(CTA)探讨椎动脉起始位置与穿出颈椎横突孔高度的关系。方法回顾性分析2017年3月至2019年3月河北医科大学第二医院神经外科行头颈上胸部CTA检查的480例患者的临床资料。将图像传输至图像后处理工作站进行骨质和血管重建,观察双侧椎动脉的起源、走行及穿出颈椎横突孔的高度。对于右侧椎动脉起源正常者,根据穿出颈椎横突孔的高度分为C₄、C₅、C₆组,每组随机选取10例分别测量右侧椎动脉起始位置至右侧颈总动脉起始的距离(L1)和右侧甲状颈干的距离(L₂),以L₁/(L₁+L₂)×100%计算椎动脉起始的相对位置。结果480例患者中,457例(95.2%)双侧椎动脉起源位置正常,均起源于锁骨下动脉,另23例(4.8%)起源异常,其中左侧椎动脉起源于主动脉弓19例、左侧颈外动脉1例;右侧椎动脉起源于右侧颈总动脉3例,且均合并迷走右锁骨下动脉。480例患者中,405例(84.4%)双侧椎动脉经C₆横突孔穿出;另75例(15.6%)穿出高度异常,其中左侧34例,经C₃、C₄、C₅、C₇横突孔穿出的分别有1、4、24、4例,直接入枕骨大孔1例;右侧41例,经C₃、C₄、C₅横突孔穿出的有1、14、26例。椎动脉起源异常的患者,左侧椎动脉起自主动脉弓的占比最高(19/20),且多数穿出颈椎横突孔的高度异常(18/19);右侧椎动脉均起自右侧颈总动脉合并迷走右锁骨下动脉(3/3),且穿出颈椎横突孔的高度均异常(3/3)。椎动脉起源正常的患者,96.7%(445/460)的左侧椎动脉穿出颈椎横突孔的高度正常,92.0%(439/477)的右侧椎动脉穿颈椎横突孔高度正常。3组右侧椎动脉起源正常的患者椎动脉起始的相对位置的差异有统计学意义[C₄组:(24.3±2.1)%、C₅组:(47.9±6.6)%、C₆组:(77.7±1.7)%,H=20.178,P<0.001]。结论椎动脉起始位置异常时,其穿出颈椎横突孔的高度多异常。右侧椎动脉的起始相对位置越靠近右侧颈总动脉时,穿出颈椎横突孔的高度越高;而越靠近右侧甲状颈干,穿出颈椎横突孔的高度越低。     

Cervical Radiculopathy Caused by Vertebral Artery Loop Formation : A Case Report and Review of the Literature

Vertebral artery loop formation causing encroachment on cervical neural foramen and canal is a rare cause of cervical radiculopathy. We report a case of 61-year-old woman with vertebral artery loop formation who presented with right shoulder pain radiating to her arm for 2 years. Plain radiograph and computed tomography scan revealed widening of the right intervertebral foramen at the C5-6 level. Magnetic resonance imaging and angiogram confirmed the vertebral artery loop formation compressing the right C6 nerve root. We had considered microdecompressive surgery, but the patient''s symptoms resolved after conservative management. Clinician should keep in mind that vertebral artery loop formation is one of important causes of cervical radiculopathy. Vertebral artery should be visualized using magnetic resonance angiography in suspected case.     

Anatomical Morphometric Study of the Cervical Uncinate Process and Surrounding Structures

Objective

The purpose of this study is to elucidate the anatomic relationships between the uncinate process and surrounding neurovascular structures to prevent possible complications in anterior cervical surgery.

Methods

Twenty-eight formalin-fixed cervical spines were removed from adult cadavers and were studied. The authors investigated the morphometric relationships between the uncinate process, vertebral artery and adjacent nerve roots.

Results

The height of the uncinate process was 5.6-7.5 mm and the width was 5.8-8.0 mm. The angle between the posterior tip of the uncinate process and vertebral artery was 32.2-42.4°. The distance from the upper tip of the uncinate process to the vertebral body immediately above was 2.1-3.3 mm, and this distance was narrowest at the fifth cervical vertebrae. The distance from the posterior tip of the uncinate process to the nerve root was 1.3-2.0 mm. The distance from the uncinate process to the vertebral artery was measured at three different points of the uncinate process : upper-posterior tip, lateral wall and the most antero-medial point of the uncinate process, and the distances were 3.6-6.1 mm, 1.7-2.8 mm, and 4.2-5.7 mm, respectively. The distance from the uncinate process tip to the vertebral artery and the angle between the uncinate process tip and vertebral artery were significantly different between the right and left side.

Conclusion

These data provide guidelines for anterior cervical surgery, and will aid in reducing neurovascular injury during anterior cervical surgery, especially in anterior microforaminotomy.     

磁共振成像在脊髓型颈椎病临床研究中的意义

分析50例脊髓型颈椎病的临床和磁共振成像(MRI)资料，其中10例经手术治疗。50例中共有123个推间盘变性，其中突出73个，髓桩游离7个。33例主要因椎间盘等软组织异常致颈髓损害，17例主要因颈椎骨性结构退变致颈髓损害。结果提示，临床症状的轻重与椎间盘病变程度和是否存在骨性椎管狭窄密切相关。MRI显示的特征性信息，可为判断致病因素、颈髓损伤程度、确定诊断、鉴别诊断和选择治疗方法等提供重要依据。     

Vertebral Artery Anomaly Causing C2 Suboccipital Neuralgia,Relieved by Neurovascular Decompression

We report imaging and surgical findings of a symptomatic 40‐year‐old male with an anomalous left vertebral artery. MR, CT myelography, angiography, and intraoperative photos demonstrate the vertebral artery entering the thecal sac at the C1‐C2 intervertebral foramen and compressing the dorsal C2 nerve rootlets against the cord. Open microvascular decompression alleviated the patient's long‐standing suboccipital and posterior cervical neck pain. An embryologic review of the vertebral and lateral spinal artery systems reveals possible developmental explanations for this variant. Intradural course of the vertebral artery at C2 is one of the few symptomatic developmental vertebral artery anomalies. Recognition of this condition is important because surgical intervention can alleviate associated neck pain.     

脊髓型颈椎病手术治疗后疗效观察

目的：脊髓型颈椎病手术治疗后１￣１２年随访检查者１１２例,观察其疗效。方法：收集我院１９８６￣１９９８年间住院采用了颈前路手术摘除颈椎间盘加自体髂骨融合术治疗１４８例患者,经发函,通知来院复查者计１１２例,对此进行统计分析。结果：疗效达优良者为６１＾（６８例／１１２例）,总有效率９３％（１０４例／１１２例）。结论：提示该治疗方法有可行性。     

Microsurgical anterior cervical foraminotomy in spondylogenous cervical radiculopathy

The authors present the results of microsurgical anterior cervical foraminotomy used in unilateral cervical radiculopathy caused by lateral disc herniation or foraminal stenosis. In 2000 to 2006, anterior cervical foraminotomy was performed at one or two adjacent levels in 44 patients (27 males and 17 females aged 18 to 64 years (mean age 43 years)) with cervical radiculopathy and myelopathy. All the patients underwent pre- and postoperative computed tomography, magnetic resonance imaging, and functional X-ray study. The surgical technique permitted anterior decompression of the affected nerve root from the site of its formation to the vertebral artery, by maintaining the stability and mobility of the involved vertebral segments. The immediate postoperative period was marked by excellent results with regression of radicular syndrome in 84% of the patients and by good results in 16%. A late (6-month-to-6-year) follow-up showed excellent (78%) and good (22%) results without additional surgery. The findings indicate that anterior cervical foraminotomy is an effective technique of nerve root decompression in patients with lateral disc herniation or foraminal stenosis.     

Intervertebral disc calcification with neurological symptoms in children: report of conservative treatment in two cases

Purpose

Intervertebral calcifications are rare in the paediatric population. Two cases of children with symptomatic intervertebral calcifications responsible for spinal cord compression and neurological compromise are presented.

Methods

The data of two children treated conservatively for a symptomatic intervertebral calcification responsible for spinal cord compression and neurological compromise were retrospectively reviewed.

Results

Frontal and lateral radiographs are usually sufficient to determine the presence and extent of the calcified cervical disc protrusion. Conservative treatment with antalgics and bracing was applied in both cases. The two patients were completely free of symptoms 4 weeks after initial treatment. Magnetic resonance imaging screening showed a complete vertebral canal clearance at final follow-up.

Conclusion

Despite the lack of significance due to the small number of patients, conservative treatment should be considered in children with moderate neurological symptoms due to calcified disc protrusion.     

神经源性间歇跛行42例临床分析

对４２例神经源性间歇跛行综合征进行回顾性研究，发现本病好发于中老年男性，腰椎退行性变和（或）腰椎间盘突出造成的腰椎管狭窄是本病的直接原因。在诊断上腰椎Ｘ线平片可提供一定的线索，脊髓造影或无创伤性脊髓ＣＴ及ＭＲＩ检查是本病的最主要手段。早期诊断并及时手术治疗预后较好。