共查询到20条相似文献,搜索用时 15 毫秒
1.
Benign and primary malignant tumors of the spine require a ventral procedure to remove the tumor and to stabilize the spine.Experience in the last years has shown that sole laminectomy in children can no longer be recommended. An instrumentation of the spine to prevent kyphosis must be performed. The rate of pseudarthrosis was of course, high when the kyphosis was treated by an exclusive dorsal instrumentation. In patients with severe kyphosis a combined procedure with ventral and dorsal operation is necessary [9].Solitary metastases of cancer of the prostate, breast, and the thyreoid gland show a better prognosis than metastases of cancer of the lung or the stomach. Thus metastases of the first group which also show a dependency on hormones, should be operated on by a ventral procedure, independent of the location of the tumor.In cases of multiple metastases and bad condition of the patient a ventral operation is not indicated. In these cases, a dorsal procedure with decompression and stabilization allows mobility of the patients until only few days before death.An implantation of instrumentations that include a transpedicular screwing can result in spreading of the tumor to the neighboring vertebrae. Therefore, this kind of operation should be the ultima ratio. 相似文献
2.
A total of 235 lesions in 187 patients were treated radiosurgically, including 71 primary malignant brain tumors, 113 metastases, 38 arteriovenous malformations, and 13 benign brain tumors. Postradiosurgery tissue was obtained from 36 lesions in 32 of these patients (17% of total) who developed radiographic or clinical progression/necrosis—entailing 27 resections/biopsies and 9 autopsies. Of these 32 patients, 18 had primary malignant brain tumors, 11 had metastasis, and 3 had benign brain tumors. Central or peripheral residual tumor was seen in 27 of 36 (75%) specimens, including 75% of metastases, 80% of malignant brain tumors, and 50% of benign brain lesions. Residual disease was designated to be central or peripheral to the radiosurgery target. Among primary brain malignancies, the 6- and 12-month actuarial risk for persistent central/peripheral tumor was 70/75% and 55/90%, respectively. For metastatic lesions, the 6- and 12-month actuarial risk for persistent central/peripheral tumor was 60/82% and 55/82% respectively. Radiographic changes consistent with progression were confirmed histopathologically in 75% of cases and viable tumor was most common at the periphery, correlating with lower isodose lines. 相似文献
3.
4.
5.
目的:探讨颈椎转移性骨肿瘤的临床表现和治疗等。方法:对29例患者(枢椎3例,下颈椎26例)的临床表现,手术适应证,外科治疗进行分析,结果:术后随访6个月-5年,1例枢椎肿瘤术后症状无改善,呼吸衰竭死亡;25例术后局部疼痛,神经根痛缓解甚至消失,神经压迫症状改善或缓解;3例患者分别于13、19、25个月后因全身多处转移、衰竭死亡,结论:颈椎转移必骨肿瘤多数患者表现为疼痛,部分患者有神经损害的表现,手术必须考虑全身情况,限于颈椎不稳,神经功能进行性损害,疼痛剧烈,或原发灶不明,手术作为明确病理诊断以指导进一步治疗的患者,根据肿瘤侵犯悦位,患者耐受手术情况,预期寿命等选择前路,后路或前后路的一期或二期手术,手术能够稳定和重建颈椎减轻或消除患者的疼痛,维持或改善神经功能,从而改善患者的生活质量。 相似文献
6.
Spinal injuries in the pediatric age group: a review of 82 cases of spinal cord and vertebral column injuries 总被引:1,自引:0,他引:1
A review of 82 children with spinal cord and/or vertebral column injury treated in our department between 1968 and 1993 showed that 67% of the patients were boys and the average age was 11.4 years. The cause, vertebral level, and type of injury, and the severity of neurological injury varied with the age of the patient. The cause of pediatric injuries differed from that of adult injuries in that falls were the most common causative factor (56%) followed by vehicular accidents (23%). The most frequent level of spinal injury was in the cervical region (57%, 47 patients) followed by the lumbar region (16.5%, 13 patients). In our series, 18% of the patients had complete injury and the overall mortality rate was 3.6%. Eleven children (13%) had spinal cord injury without radiographic abnormality (SCIWORA), whereas 39 (47%) had evidence of neurological injury. Although the spinal injury patterns differed between children and adolescents, the outcome was found to be predominantly affected by the type of neurological injury (P<0.05). Children with complete myelopathy uniformly remained with severe neurological dysfunction; children with incomplete myelopathy recovered nearly normal neurological function. Finally, the authors conclude that most spinal injuries can be successfuly managed with nonoperative therapy. The literature is reviewed as to the treatment and outcome of pediatric spinal injuries. 相似文献
7.
We describe a minimally invasive arthroscopic technique for anterior diskectomy of the cervical spine. Fingertip pressure is applied between the carotid sheath laterally and the pharynx medially. The trachea and esophagus are displaced to the contralateral side. The disk level, soft-tissue thickness, and midline are verified with image intensification. A spinal needle is inserted through the soft tissue into the disk space at the midline. Contrast is injected to facilitate visualization. While maintaining displacement of the pharynx, a 4-mm vertical incision is made to incorporate the needle and is enlarged bluntly. A guidewire is passed through the needle. A dilator is passed over the guidewire, through the soft tissue, and usually into the disk, stopping posterior to the mid-vertebral body, as verified with lateral imaging. A cannula is placed over the dilator, and the dilator and wire are removed. Occasionally, the cannula is passed over the dilator to the anterior aspect of the disk, and the dilator is replaced with a trephine to penetrate the anterior spinal ligament, osteophytes, and annulus. The cannula seated in the middle of the disk allows diskectomy to commence with small rongeurs through the cannula, followed by a cervical spine arthroscope with a working channel. The arthroscope is removed, and further diskectomy is performed under fluoroscopic guidance with a motorized shaver and radiofrequency probe. 相似文献
8.
Bonnie McCracken Eric Klineberg Brian Pickard David H. Wisner 《European spine journal》2013,22(7):1467-1473
Background
Flexion and extension radiographs are often used in the setting of trauma to clear a cervical spine injury. The utility of such tests, however, remains to be determined. We hypothesized that in patients who underwent a negative computed tomography (CT) cervical spine scan, flexion and extension radiographs did not yield useful additional information.Methods
We conducted a retrospective chart review of all patients admitted to a Level I trauma center who had a negative CT scan of the cervical spine and a subsequent cervical flexion–extension study for evaluation of potential cervical spine injury. All flexion–extension films were independently reviewed to determine adequacy as defined by C7/T1 visualization and 30° of change in the angle from flexion to extension. The independent reviews were compared to formal radiology readings and the influence of the flexion–extension studies on clinical decision making was also reviewed.Results
One thousand patients met inclusion criteria for the study. Review of the flexion–extension radiographs revealed that 80 % of the films either did not adequately demonstrate the C7/T1 junction or had less than 30° range of motion. There was one missed injury that was also missed on magnetic resonance imaging. Results of the flexion–extension views had minimal effects on clinical decision making.Conclusion
Adequate flexion extension films are difficult to obtain and are minimally helpful for clearance of the cervical spine in awake and alert trauma patients. 相似文献9.
André El Saman Helmut Laurer Bernd Maier Hendrik Wyen Martin Mack Ingo Marzi 《European journal of trauma and emergency surgery》2007,33(5):501-511
Abstract Treatment of polytrauma patients has been discussed extensively during the past decades. Management in the prehospital phase,
on admission, and in the early postoperative/ICU-period has to refer to injury severity, priority of injuries, and likelihood
of development of multi organ failure. Cervical spine injuries are reported in 4–34% of polytrauma cases. Securing the cervical
spine by a hard collar is one of the basic procedures in the prehospital phase. Different strategies of assessing the cervical
spine are still discussed controversially. Since plain radiographs, CT-scan, MRI, and flexion/extension fluoroscopy still
play a role in early diagnosis of cervical spine injury, we present an analysis of cervical spine injuries in our multiple
trauma patients to elucidate our algorithm. We reviewed our data between January 2003 and December 2006 concerning epidemiology,
diagnosis and treatment of cervical spine injury in polytrauma patients. Multislice-CT (MSCT) or Multidetector-CT was used
as standard diagnostic procedures in the polytraumatized patient. In 97% of patients, CT-scanning showed to be a reliable
tool in detecting injuries of the cervical spine. Only in two patients (3%), additional MRI lead to a change in treatment
strategy. Of 66 polytraumatized patients with significant cervical spine injury, 25 (37.9%) received surgical treatment within
24 h. Sixteen patients (24.2%) were treated surgically after stabilization on ICU. There was a better outcome concerning length
of hospitalization in the “day-onesurgery” group. We consider MSCT as standard approach towards diagnosis of cervical spine
injury in polytrauma patients. MRI and flexion/extension fluoroscopy can give additional information in selected cases. 相似文献
10.
目的 总结强直性脊柱炎合并颈椎无骨折脱位型脊髓损伤的临床特征、诊断和手术治疗。方法 1986~2004年,笔者手术治疗累及颈椎的强直性脊柱炎合并无骨折脱位型脊髓损伤27例。结果 本组27例中椎管内韧带骨化18例,脊髓损伤的原因依次为韧带骨化所致的椎管狭窄,椎间盘损伤和椎体后骨刺及椎间不稳定。术前均为不完全性损伤,非手术治疗不提高脊髓功能。术后脊髓ASIA分级平均改善1级。后路手术椎板切除率、出血量、手术时间、术后引流量明显高于不合并强直性脊柱炎的患者。前路手术可达到骨性融合。结论 强直性脊柱炎合并颈椎无骨折脱位型脊髓损伤一般为不完全性损伤,损伤的内因依次为椎管内韧带骨化所致的椎管狭窄、椎间盘损伤、椎间骨赘和椎间不稳定。适当的手术可改善脊髓功能。手术难度大,风险高。 相似文献
11.
Richards PJ 《Injury》2005,36(2):248-69; discussion 270
Ethical concerns have hindered any randomised control blinded studies on the imaging required to assess the cervical spine in an unconscious trauma patient. The issue has been contentious for many years and has resulted in burgeoning but inconclusive guidance. MRI and multislice CT technology have made rapid advances, but the literature is slower to catch up. Never the less there appears to be an emerging consensus for the multiply injured patient. The rapid primary clinical survey should be followed by lateral cervical spine, chest and pelvic radiographs. If a patient is unconscious then CT of the brain and at least down to C3 (and in the USA down to D1) has now become routine. The cranio-cervical scans should be a maximum of 2 mm thickness, and probably less, as undisplaced type II peg fractures, can be invisible even on 1 mm slices with reconstructions. If the lateral cervical radiograph and the CT scan are negative, then MRI is the investigation of choice to exclude instability. Patients with focal neurological signs, evidence of cord or disc injury, and patients whose surgery require pre-operative cord assessment should be imaged by MRI. It is also the investigation of choice for evaluating the complications and late sequela of trauma. If the patient is to have an MRI scan, the MR unit must be able to at least do a sagittal STIR sequence of the entire vertebral column to exclude non-contiguous injuries, which, since the advent of MRI, are now known to be relatively common. Any areas of oedema or collapse then require detailed CT evaluation. It is important that cases are handled by a suitably skilled multidisciplinary team, and avoid repeat imaging due to technical inadequacies. The aim of this review is to re-examine the role of cervical spine imaging in the context of new guidelines and technical advances in imaging techniques. 相似文献
12.
13.
14.
两种人工骨椎体成形术在胸腰椎骨折治疗中的近期疗效 总被引:3,自引:0,他引:3
目的前瞻性地研究两种不同方法的椎体成形术在胸腰椎骨折治疗中的疗效比较。方法自2002年以来,我科共收治128例胸腰椎骨折患者,按AO分型均为A型。随机分成两组:A组64例,在后路椎弓根螺钉复位内固定的基础上应用注射型人工骨进行椎体成形,术前矢状面指数(SI)平均为34°;B组64例,在后路椎弓根螺钉复位内固定的基础上应用固态人工骨进行椎体成形,SI平均为36°。结果所有患者平均随访18.5个月,A组术后即刻SI平均为13°,椎体终板高度丢失平均为4.0mm,在最后随访时SI和终板高度丢失无明显变化;B组术后即刻SI平均为4.5°,椎体终板高度丢失平均为1.0mm,在最后随访时SI和终板高度丢失无明显变化。A组与B组之间术前SI差异无显著性意义(P>0.05);术后即刻及最后随访时SI差异均有极显著性意义(P<0.01),术后即刻及最后随访时终板高度丢失差异均有极显著性意义(P<0.01)。结论胸腰椎骨折行后路复位内固定时,进行椎体成形不仅能够有效地填充椎体内骨缺损空腔,避免术后复位效果的丢失,而且用固态人工骨进行椎体成形,能改善椎体终板塌陷的复位效果,也比注射型人工骨更安全,不会渗漏至椎管内造成严重的并发症。术后长期疗效仍有待进一步随访研究。 相似文献
15.
The C1 claw device: a new instrument for C1-C2 fusion 总被引:1,自引:0,他引:1
A new fixation device for C1-C2 fusion is presented. It consists of a claw construct for the C1 arch that is rigidly attached to C1-C2 transarticular screws to form an instrument that combines anterior and posterior fixation in the same construct. The new device was successfully applied in a case with failed C1-C2 fusion that was initially stabilized with transarticular screws alone, where the usual posterior wiring was omitted due to a defect of the posterior C1 arch. 相似文献
16.
椎动脉CT血管造影在颈椎肿瘤患者中的应用及临床意义 总被引:1,自引:0,他引:1
目的:探讨椎动脉CT血管造影(CTA)在颈椎肿瘤患者中的应用及临床意义.方法:自2007年1月至2009年4月,对肿瘤累及一侧或双侧横突、椎间孔,与椎动脉关系密切的27例患者实施椎动脉CTA,男12例,女15例.年龄7~69岁,平均39.3岁.累及C1或C2者12例,累及下颈椎者15例.结果:1例多骨型纤维异常增殖症患者右侧椎动脉第二段自右侧C5横突孔进入.肿瘤累及右侧椎动脉者10例,累及左侧椎动脉者11例,累及双侧椎动脉者6例.未受累椎动脉通畅.14例患者的肿瘤包绕17支椎动脉,其中11例的14支受累椎动脉直径变细;8例患者肿瘤推挤10支椎动脉,其中6例8支受累椎动脉直径变细;5例肿瘤仅邻近椎动脉,未对椎动脉产生影响.椎动脉第一段受累者4例.第二段受累者10例,第三段受累者9例,同时累及第二和第三段者4例.根据肿瘤的性质实施姑息性切除、经瘤刮除或边缘切除,术中2例累及椎动脉第二、三段的脊索瘤患者一侧椎动脉破裂,行椎动脉结扎,术后无神经功能损害.结论:颈椎肿瘤常累及椎动脉,术前椎动脉CTA能够了解椎动脉与肿瘤和相邻骨结构的关系.评估受累椎动脉及对侧椎动脉通畅情况,指导术中暴露和处理受累椎动脉,避免术前椎动脉栓塞和术中预防性椎动脉结扎带来的潜在风险. 相似文献
17.
Bharti Khurana S. Mohammed Karim Jay M. Zampini Hamdi Jimale Charles H. Cho Mitchel B. Harris Aaron D. Sodickson Christopher M. Bono 《The spine journal》2019,19(3):403-410
PURPOSE
To assess whether a focused magnetic resonance imaging (MRI) limited to the region of known acute traumatic thoracic or lumbar fracture(s) would miss any clinically significant injuries that would change patient management.STUDY DESIGN/SETTING
A multicenter retrospective clinical study.PATIENT SAMPLE
Adult patients with acute traumatic thoracic and/or lumbar spine fracture(s).OUTCOME MEASURES
Pathology identified on MRI (ligamentous disruption, epidural hematoma, and cord contusion), outside of the focused zone, an alteration in patient management, including surgical and nonsurgical, as a result of the identified pathology outside the focused zone.METHODS
Records were reviewed for all adult trauma patients who presented to the emergency department between 2008 and 2016 with one or more fracture(s) of the thoracic and/or lumbar spine identified on computed tomography (CT) and who underwent MRI of the entire thoracic and lumbar spine within 10 days. Exclusion criteria were patients with >4 fractured levels, pathologic fractures, isolated transverse, and/or spinous process fractures, prior vertebral augmentation, and prior thoracic or lumbar spine instrumentation. Patients with neurologic deficits or cervical spine fractures were also included. MRIs were reviewed independently by one spine surgeon and one musculoskeletal fellowship-trained emergency radiologist for posterior ligamentous complex (PLC) integrity, vertebral injury, epidural hematoma, and cord contusion. The surgeon also commented on the clinical significance of the pathology identified outside the focused zone. All cases in which pathology was identified outside of the focused zone (three levels above and below the fractures) were independently reviewed by a second spine surgeon to determine whether the pathology was clinically significant and would alter the treatment plan.RESULTS
In total, 126 patients with 216 fractures identified on CT were included, with a median age of 49 years. There were 81 males (64%). Sixty-two (49%) patients had isolated thoracolumbar junction injuries and 36 (29%) had injuries limited to a single fractured level. Forty-seven (37%) patients were managed operatively. PLC injury was identified by both readers in 36 (29%) patients with a percent agreement of 96% and κ coefficient of 0.91 (95% CI 0.87–0.95). Both readers independently agreed that there was no pathology identified on the complete thoracic and lumbar spine MRIs outside the focused zone in 107 (85%) patients. Injury outside the focused zone was identified by at least one reader in 19 (15%) patients. None of the readers identified PLC injury, cord edema, or noncontiguous epidural hematoma outside the focused zone. Percent agreement for outside pathology between the two readers was 92% with a κ coefficient of 0.60 (95% CI 0.48–0.72). The two spine surgeons independently agreed that none of the identified pathology outside of the focused zone altered management.CONCLUSIONS
A focused MRI protocol of three levels above and below known thoracolumbar spine fractures would have missed radiological abnormality in 15% of patients. However, the pathology, such as vertebral body edema not appreciated on CT, was not clinically significant and did not alter patient care. Based on these findings, the investigators conclude that a focused protocol would decrease the imaging time while providing the information of the injured segment with minimal risk of missing any clinically significant injuries. 相似文献18.
Summary The laminae were removed from the lower lumbar spines of five cadavers within four hours of death. A short length of rubber tube was inserted between the nerve roots and the lumbar disc and the tension monitored using semiconductor pressure transducers. The angulatory stresses exerted on the lumbar nerve roots during tension sign tests were found to correspond to clinical experience.
Résumé Les lames des dernières vertèbres lombaires ont été réséquées sur cinq cadavres dans les quatre heures suivant la mort. Un court tube de caoutchouc a été inséré entre les racines nerveuses et le disque lombaire; la tension a été ensuite enregistrée grâce à des capteurs de pression transistorisés. Les stress angulaires exercés sur les racines lombaires lors de la recherche des signes de tension correspondent aux résultats fournis par l'expérience clinique.相似文献
19.
Introduction
Although pedicle screw fixation is a well-established technique for the lumbar spine, screw placement in the thoracic spine is more challenging because of the smaller pedicle size and more complex 3D anatomy. The intraoperative use of image guidance devices may allow surgeons a safer, more accurate method for placing thoracic pedicle screws while limiting radiation exposure. This generic 3D imaging technique is a new generation intraoperative CT imaging system designed without compromise to address the needs of a modern OR.Aim
The aim of our study was to check the accuracy of this generic 3D navigated pedicle screw implants in comparison to free hand technique described by Roy-Camille at the thoracic spine using CT scans.Material and methods
The material of this study was divided into two groups: free hand group (group I) (18 patients; 108 screws) and 3D group (27 patients; 100 screws). The patients were operated upon from January 2009 to March 2010. Screw implantation was performed during internal fixation for fractures, tumors, and spondylodiscitis of the thoracic spine as well as for degenerative lumbar scoliosis.Results
The accuracy rate in our work was 89.8 % in the free hand group compared to 98 % in the generic 3D navigated group.Conclusion
In conclusion, 3D navigation-assisted pedicle screw placement is superior to free hand technique in the thoracic spine. 相似文献20.
J. N. Grauer Jonathan S. Erulkar Tushar C. Patel Manohar M. Panjabi 《European spine journal》2000,9(3):250-255
Physiologic motions of the human, sheep, and calf lumbar spines have been well characterized. The size, cost, and ease of
care all make the rabbit an attractive alternative choice for an animal lumbar spine model. However, comparisons of normal
biomechanical characteristics of the rabbit lumbar spine have not been made to the spines of larger species. The purpose of
this study was to establish baseline physiologic kinematic data for the rabbit lumbar spine. Ten skeletally mature New Zealand
white rabbit osteoligamentous spines were obtained. L4-L7 spine segments were harvested and mounted. Multi-directional flexibility
testing was performed by applying pure moments up to 0.27 Nm. Resulting rotations were measured using an Optotrak system.
Data were analyzed for each intervertebral level in the three planes of rotation. The three levels tested had roughly similar
range of motion (ROM). The mean (SD) angular ROMs in flexion for L4-L5, L5-L6, L6-L7 were 12.10° (2.59°), 12.38° (2.70°),
and 15.17° (3.22°), respectively. The ROMs in extension were 5.86° (1.21°), 5.58° (1.48°), and 6.13° (2.03°). Lateral bending
and axial rotation were roughly symmetric due to the symmetric nature of the spine. For right lateral bending, the ROMs were
8.25° (2.44°), 4.96° (1.70°), and 4.25° (1.20°). For left axial rotation, the ROMs were 1.23° (1.16°), 0.35° (0.61°), 0.87°
(0.64°). Neutral zone (NZ) was on average 60% (29%) of ROM for the motions studied. The physiologic ROM of the New Zealand
white rabbit lumbar spine was found to be similar between the rabbit and human. This relatively conserved physiologic flexibility
supports the use of the rabbit as a model of the lumbar spine for kinematic studies. However, the overall NZ was found to
be a greater percentage of ROM in the rabbit than the corresponding percentage in the human (60% as compared to 25%). This
suggested that the rabbit lumbar spine has a greater laxity than that of the human.
Received: 23 August 1999 Revised: 15 December 1999 Accepted: 26 January 2000 相似文献