生物活性玻璃联合颈椎椎间融合器在颈椎前路椎间融合中的应用

背景：已有文献报道生物活性玻璃在骨不连、骨折愈合过程中有较佳的临床疗效,但其在脊柱骨融合过程中的效果鲜有报道。 目的：观察生物活性玻璃联合颈椎椎间融合器在颈椎前路椎间融合中应用的安全性和有效性。 方法：回顾性分析68例颈椎前路单节段椎间融合患者资料,全部病例均采用聚醚醚酮材料椎间融合器,其中内填充自体松质骨植骨32例为对照组,采用生物活性玻璃填充36例为实验组。随访观察两组植骨融合、神经功能恢复、椎间隙高度和颈椎生理曲度及伤口并发症等情况。 结果与结论：两组患者的神经功能改善效果相当,均未出现伤口感染及延迟愈合等并发症。治疗3个月时,实验组与对照组骨性融合率分别为94%,97%,组间比较差异无显著性意义;治疗6个月时全部融合。两组随访3,6,12个月时椎间隙高度和颈椎曲度指数均获得良好维持,组间比较差异无显著性意义。提示生物活性玻璃联合颈椎椎间融合器在颈椎前路椎间融合中有良好的临床安全性和有效性。     

Combined Use of a True-Bipolar Sensing Implantable Cardioverter Defibrillator in a Patient Having a Prior Implantable Spinal Cord Stimulator for Intractable Pain

Reported is a case involving a patient with a previously implanted spinal cord stimulator (SCS) who presented for an implantable. Cardioverter defibrillator (ICD). The SCS device was located in the left lower abdominal quadrant with a stimulation electrode array placed on the dorsal aspect of the spinal cord at the T-11 thoracic level. Interaction testing demonstrated that the bipolar sensing transvenous ICD system (Medtronic 7221Cx PCD) did not detect the stimulator's output at burst rates ranging from 20–130 pulses/s, even with the ICD set to its maximum sensitivity of 0.15 mV and the stimulator programmed to the highest patient tolerated output combinations of 5 V, 0.45 ms in the bipolar configuration and 3 V, 0.45 ms in the unipolar (i.e., case-electrode) configuration.     

In vivo evaluation of biomechanical anterior cervical plate failure

Anterior cervical plate (ACP) failure is rarely addressed in the literature. In this retrospective, observational, longitudinal, cohort study, the objectives were to (1) identify incidences of in vivo biomechanical failure in commercially available, US Food and Drug Administration-approved ACP systems, (2) describe modes of failure, (3) suggest structural explanations for system failure, and (4) discuss complications and treatment of patients with failed ACP systems. Investigators retrospectively identified patients who underwent anterior cervical procedures followed by use of ACP as a fusion adjunct and showed evidence of ACP failure on plain radiographs. Components of the ACP system that led to failure were identified and examined. A total of 240 patients received ACP supplementation of anterior cervical fusion constructs during the 9.5-y study period. Evidence of ACP failure was noted in 7 patients (3.3%), and an eighth patient was referred for evaluation after ACP failure. Screw-plate interface failure occurred in all 8 cases. The biomechanical method by which the bone screw head was secured into the vertebral body, or against the ACP, the use of hybrid systems, the surgical technique selected, and host factors were used to determine the rate of failure. Concern for esophageal or other tissue injury often necessitated ACP removal. Screw-plate interface failure, which was found to be the most common mode of biomechanical ACP failure, may occur in hybrid constructs and in systems that do not create a rigid interface between the screw head and the ACP. Surgical technique and patient host factors may also influence the rate of biomechanical construct failure.     

氮化纯钛颈椎植骨融合器的研制及生物力学测试

目的:根据国人颈椎特点设计研制了一种经氮化处理的纯钛植骨融合器,并进行生物力学测试。方法:取12具新鲜成年男性颈椎标本,分别处理成包含单、双运动功能单位的试样,模拟前路植骨及植人融合器,进行前屈、后伸、侧弯、扭转四个方面的测试,比较本融合器植人后与完整颈椎及单纯椎间植骨的稳定性,经统计学分析后自编程序拟合出载荷—位移曲线和扭矩一扭转角曲线。同时进行疲劳强度和强度破坏试验。结果:融合器植人后颈椎在各方向运动中的稳定性均明显强于单纯椎间植骨,也较完整颈椎运动功能单位稳定。结论:纯钛颈椎植骨融合器适用于前路间盘摘除减压手术的椎间固定融合,尤其是多节段病变的病例。     

下颈椎不稳对颈椎后纵韧带骨化症早期发病的影响

目的探讨下颈椎不稳与颈椎后纵韧带骨化症(OPLL)早期发病的关系。方法对76例OPLL患者及30例正常人行颈椎X线摄片、CT及MRI检查。在颈椎屈曲/伸展侧位片上测量全颈椎活动范围、椎体水平移位及成角程度,根据MRIT2加权像观察脊髓内高信号变化,并与临床资料对比分析。结果OPLL患者颈椎屈伸范围比正常人明显减小(P<0.01),下颈椎不稳发生率比正常人明显增高(P<0.01)。OPLL合并下颈椎不稳的患者,神经系统受损程度和脊髓受压程度不平行,产生重于影像学表现的临床症状。结论下颈椎不稳加速OPLL症的发生和发展。     

人工颈椎间盘置换与融合治疗颈椎病：中短期疗效的比较

背景：近年来,以人工颈椎间盘置换为代表的非融合技术不断改进,在重建受累节段间盘结构和功能的基础上,使得术区节段颈椎结构显著接近天然生理系统所要求的动静态负荷应力分布,在保护退变节段椎间小关节及邻近节段颈椎结构功能及维持颈椎动态稳定性方面作用显著,表现出较节段融合技术明显的方法学优势。 目的：评价颈前路椎间盘切除融合与Bryan人工颈椎椎间盘置换治疗单节段间盘退变性脊髓或神经根型颈椎病的临床效果。 方法：纳入2010年3月至2012年3月收治的43例单节段退变的脊髓或神经根型颈椎病中老年患者,随机分为前路颈椎间盘切除加椎间植骨融合组（融合组）和Bryan人工椎间盘置换组。治疗前后通过X射线影像学检查观察颈椎整体及目标间隙上下邻近椎间活动度的变化;随访期间应用日本骨科协会评分、颈痛目测类比评分和颈椎功能障碍指数进行术后神经功能恢复评估。 结果与结论：所有患者术中及术后未出现神经血管损伤的并发症。人工椎间盘置换组术后整体颈椎及邻近关节活动度较融合组有所改善;术后各组患者神经功能均较术前明显改善,术后3个月人工椎间盘置换组日本骨科协会评分、颈痛目测类比评分及颈椎功能障碍指数均较融合组明显改善（P〈0.05）,末次随访时除颈痛目测类比评分两组间有差异外,其余神经功能两组恢复情况相同。随访期间未见假体下沉、偏移及异位骨化现象。提示人工颈椎间盘置换能有效保持颈椎节段活动度,并对邻近节段间盘退变有一定的保护作用,中期随访可取得与融合手术相当的神经功能改善效果,非融合技术在单节段颈椎病的中短期疗效优于融合技术。     

Less invasive anterior fusion of the cervical spine

Summary

Trauma, degenerative and inflammatory diseases, or tumours may destabilise and deform the cervical spine, causing compression of the spinal cord and/or the nerve roots. The goals of surgical therapy are decompression of the neurostructures and restoration of the physiological alignment, along with stabilisation by fusion and fixation of the affected vertebrae. ‘Minimally invasive’ defines an effective surgical treatment with the least morbidity for the patient. The combined use of computed tomography (CT) and MRI, microsurgical techniques, intra-operative fluoroscopy and devices for internal fixation (plates and screws) has significantly improved the outcome. Nowadays bone graft substitutes, endoscopy and image-guided navigation are being introduced for clinical use, in order to reduce the surgical morbidity even further. Benefits of this evolution are: surgical procedures tailored for different pathologies; early mobilisation and rehabilitation, especially of elderly patients. Disadvantages are: a rapidly increasing number of operative procedures with a demanding learning curve, which have to be performed at specially qualified centres; and increasing sophistication (as a potential source of error) of the surgical equipment. A more balanced cooperation between industry and clinicians, along with an ethical agreement on how much surgery should be done, has become mandatory.     

颈椎前路单纯椎间融合器与钢板并用恢复颈椎生理曲度

目的探讨单纯应用椎间融合器(CAGE)及CAGE与ORIEN钢板联合应用对椎间高度变化率、颈椎前弯变化率的影响。方法采用CAGE或与ORIEN钢板联合应用治疗颈椎损伤、脊髓型颈椎病、颈椎退变78例,随访6～15个月,观察椎间高度变化率、颈椎前弯变化率、融合率及并发症。结果术后两组的颈椎生理曲线、椎间高度的改变无显著差别,但CAGE与ORIEN钢板联合应用组的融合率明显高于单纯CAGE组。结论CAGE与ORIEN钢板联合应用弥补了单独应用CAGE时稳定上的欠缺,组合后对椎间高度变化、颈椎前弯变化及植骨融合率均较单独应用有明显优势。     

含骨形态发生蛋白2骨修复材料在颈椎前路减压植骨融合中的应用

背景：颈椎前路椎间盘切除减压自体髂骨植骨融合是治疗颈椎病的标准术式,但取自体髂骨存在较多供骨区并发症,寻找合适的骨修复替代材料应用于颈椎前路手术一直是研究的热点。 目的：分析含骨形态发生蛋白2骨修复材料在颈椎前路减压融合中的临床效果。 方法：回顾性分析行颈前路减压植骨融合治疗40例患者的临床资料,其中试验组21例将含骨形态发生蛋白2的骨修复材料（载体为药用明胶、注射用大豆卵磷脂、羟基磷灰石等）及自体骨赘植入PEEK cage融合器,对照组19例将自体骼骨植入PEEK cage融合器。随访12个月,比较两组融合节段Cobb角、融合节段椎体前缘高度、椎间高度、并发症、融合率、JOA评分和目测类比评分等指标。 结果与结论：经过治疗后,两组均获得了即刻的颈椎稳定,颈椎前凸、融合节段椎体前缘高度及椎间高度均较治疗前明显增加（P〈0.05）。随访12个月时,试验组Cobb角明显大于对照组（P〈0.05）,两组融合节段椎间隙前缘高度与融合节段椎间高度、椎间融合率、颈部与上肢目测类比评分、JOA评分比较差异无显著性意义,均获得骨性愈合。表明含骨形态发生蛋白2的骨修复材料结合自体骨赘植骨应用于颈椎前路减压融合可有效恢复并维持颈椎前凸、融合节段的高度,在改善临床症状方面与自体髂骨疗效相当。     

颈前路植骨融合术患者的护理

笔报道采用颈前路椎间盘除结合椎体间植骨融合术患的护理。总结了术前的护理重点：(1)心理护理;(2)术前训练。术后护理要点：(1)密切观察血压、脉搏、呼吸;(2)注意头颈部制动;(3)预防并发症：脊柱反应性水肿、感染;(4)减少呼吸道分泌物：(5)做好出院指导。     

颈脊柱推拿对减轻慢性颈痛患者肘屈肌抑制机制研究

目的:通过对16例慢性颈痛患者进行研究,测量颈痛患者行颈脊柱推拿前后功能量和主观疼痛改变情况。方法:颈脊柱推拿选定C5-7水平,用插入颤搐方法和肌电描记法评定肘屈肌在最大范围内随意收缩时二头肌激活作用。颈活动度和压痛阈用关节角度计和痛觉计进行测量。结果:治疗前,患者表现典型的二头肌抑制,颈部活动侧面受限,压痛敏感性增高。颈脊柱推拿后,二头肌抑制明显下降并伴随二头肌肌力增强,颈部活动度和压痛阈显著提高。结论:脊柱推拿术可以提高肌肉功能、颈部活动度和疼痛敏感性。     

颈椎前路融合与置换体外生物力学实验的新观点

背景：传统“金标准”颈前路减压植骨融合及近年来迅速发展的人工颈椎间盘置换是临床上常见的治疗颈椎病的方式。大量科研工作者和临床医生希望通过颈椎体外标本实验研究脊柱生物力学,为临床治疗提供指导数据。 目的：对现有颈椎体外标本生物力学实验研究进展进行综述,并对未来的研究方向进行展望。 方法：以“Cervical Spine, Fusion, Replacement, Hybrid, Biomechanics, In vitro, Adjacent-level Degeneration, Review”为英文检索词检索Pubmed数据库,以“颈椎,融合,置换,混合术,生物力学,体外,相邻节段退变,综述”为检索词检索CNKI数据库和万方数据库,检索2007年1月至2013年3月有关颈椎前路融合与置换体外生物力学实验研究进展的文献,主要整理近3年来相关研究,排除陈旧文章和重复性工作,最后对40篇文献进行归纳与讨论。 结果与结论：文章对现有的颈椎体外标本融合、置换实验进行总结,集中体现在手术多节段、运动控制条件差异化、颈椎耦合运动测试和新型植入器械4个方面,对比总结融合与置换治疗对邻近节段运动范围、关节内压力、髓核内压力和椎间孔形态的影响,探讨融合、置换后存在的问题。最后结合临床的需求,展望颈椎体外标本实验的发展趋势及应用前景。     

Current concepts on spinal arthrodesis in degenerative disorders of the lumbar spine

Back pain is a common chronic disorder that represents a large burden for the health care system. There is a broad spectrum of available treatment options for patients suffering from chronic lower back pain in the setting of degenerative disorders of the lumbar spine, including both conservative and operative approaches. Lumbar arthrodesis techniques can be divided into sub-categories based on the part of the vertebral column that is addressed (anterior vs posterior). Furthermore, one has to differentiate between approaches aiming at a solid fusion in contrast to motion-sparing techniques with the proposed advantage of a reduced risk of developing adjacent disc disease. However, the field of application and long-term outcomes of these novel motion-preserving surgical techniques, including facet arthroplasty, nucleus replacement, and lumbar disc arthroplasty, need to be more precisely evaluated in long-term prospective studies. Innovative surgical treatment strategies involving minimally invasive techniques, such as lateral lumbar interbody fusion or transforaminal lumbar interbody fusion, as well as percutaneous implantation of transpedicular or transfacet screws, have been established with the reported advantages of reduced tissue invasiveness, decreased collateral damage, reduced blood loss, and decreased risk of infection. The aim of this study was to review well-established procedures for lumbar spinal fusion with the main focus on current concepts on spinal arthrodesis and motion-sparing techniques in degenerative disorders of the lumbar spine.     

生物活性颈椎椎间融合器的制作与基本性能研究

目的采用自行合成的羟基磷灰石(HAp)/左旋聚乳酸(PLLA)复合材料研制颈椎椎间融合器并对其基本理化性能进行检测,探索制备新型的颈椎椎融合器。方法采用化学共沉淀法和开环聚合法制备HAp和PLLA,按35/65质量比共混,经热压模铸加工成颈椎椎间融合器,检测样件的基本理化特征。结果HAp/PLLA复合材料的密度为1.64g/cm3,热压后黏均相对分子量118.309ku,样件平均极限压缩强度为128MPa,E模量5.47GPa。结论HAp/PLLA复合材料是一种化学性能稳定、机械性能良好的生物活性材料,用其制作的椎间融合器能够达到颈椎椎间支撑融合的基本要求。     

多模态MRI观察颈椎源性疼痛患者全脑结构异常

目的采用基于体素的形态学(VBM)技术和扩散张量成像(DTI)观察颈椎源性疼痛(CSP)患者全脑灰白质微结构异常,分析相应脑结构参数与临床特征的关系。方法对31例CSP患者(CSP组)和30名年龄、性别匹配的健康志愿者(对照组)分别采集全脑3D-T1WI和DTI。对CSP组进行视觉模拟评分(VAS),对2组均行汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)及蒙特利尔认知能力(MoCA)评分。比较2组全脑灰质及白质微结构的差异,分析差异有统计学意义的参数与临床指标的相关性。结果 CSP组右侧楔前叶、右侧颞上回和右侧中扣带回灰质体积均较对照组减少,且与VAS评分均呈负相关(r_s=-0.397、-0.402、-0.388,P均<0.05)。CSP组双侧上纵束各向异性分数(FA)值均减低,左侧上纵束FA值与VAS评分呈负相关(r_s=-0.460,P=0.014)。CSP组结构异常脑灰白质参数与HAMA、HAMD和MoCA评分均无明显相关(P均>0.05)。结论联合应用VBM技术及DTI可评估颈椎源性疼痛患者全脑灰白质微结构改变...     

SCT重建功能在颈椎病诊断中的应用

目的:探讨SCT重建功能在各型颈椎病诊断中的应用价值。方法:对46例(男31例,女15例)临床诊断为颈椎病的患者行全颈椎螺旋扫描,所用CT机为GEHispeedFx?i,技术参数:层厚3～5mm,Pitch1.0～1.5,重建间隔1.5～2.5mm。所得二维图像全部传输到AdvantageWorkstation4.0进行MPR、SSD重建及对感兴趣区切割,从不同角度和方向观察感兴趣区。结果:重建技术使相关影像信息更加清晰和直观,特别是对椎间孔和椎管内的显示更有价值。结论:重建增加了影像信息,为颈椎病病因诊断、临床分型、外科治疗提供了新的技术支持。     

对比分析分节段减压融合术与传统椎体次全切除融合术治疗多节段脊髓型颈椎病的中远期临床疗效

目的对比分析治疗多节段脊髓型颈椎病采用分节段减压融合术与传统椎体次全切除融合术的中远期临床效果。方法选取2012年6月到2014年11月接受手术治疗的110例多节段脊髓型颈椎病患者,根据手术方法进行分组,对照组患者实行传统椎体次全切除融合术,实验组患者实行分节段减压融合术,对比分析两组患者的临床手术指标以及中远期临床疗效。结果实验组的手术时间显著多于对照组,失血量显著少于对照组,差异有统计学意义(P0.05)。实验组患者中远期的融合节段角度(8.45±4.83)°、全颈椎增加角度(12.89±4.27)°显著低于对照组患者中远期的融合节段角度(10.55±2.87)°、全颈椎增加角度(14.45±4.72)°;两组患者在手术前、术后1个月和6个月的中期的JOA脊髓功能评分和JOA脊髓功能改善率差异无统计学意义(P0.05);实验组患者在术后12个月和18个月的远期的JOA脊髓功能评分和JOA脊髓功能改善率显著优于对照组,差异有统计学意义(P0.05)。结论分节段减压融合术治疗多节段脊髓型颈椎病的中远期临床效果优于传统椎体次全切除融合术,具有重要临床应用价值。     

钛网在颈椎前路融合中的应用

【目的】评价钛网替代技术进行颈椎前路融合,维持颈椎生理前凸的临床效果。【方法】对14例颈椎疾患病人进行前路颈椎次全切(或颈椎间盘切除)、椎管减压、钛网内添自体松质骨椎间融合、颈椎前路钢板锁定系统内固定手术,并评定疗效和进行影像学结果分析。【结果】患者平均住院天数7(6~8)d,所有病人的神经症状术后得到不同程度的恢复;术后影像学资料提示钢板位置良好,无钛网脱出;术后随访时间11.8(6~18)个月,所有病人获得了颈椎间融合,固定节段区的整体生理前凸平均改变1.3°,后凸平均改变0.2°。【结论】钛网植骨可以避免取髂骨所带来的并发症,联合颈椎前路锁定钢板系统替代技术可以有效地进行颈椎前路融合和维持颈椎生理曲度。     

颈前路带锁钢板对单间隙脊髓型颈椎病颈椎曲度及高度的影响

目的通过对单间隙脊髓型颈椎病颈前路减压植骨融合、使用或不使用颈前路带锁钢板内固定的患者术后随访,分析不同术式对颈椎曲度和高度的影响。方法对45例单间隙脊髓型颈椎病手术治疗的患者进行随访12～38个月,平均20个月,其中A组行颈前路减压单纯植骨融合20例,B组行颈前路减压植骨融合+颈前路带锁钢板内固定25例,分别在术前、术后1周内、术后2～4个月、术后5～7个月、术后1年以上拍摄颈椎标准侧位片,测量融合节段颈椎前高、后高、颈椎总曲度、融合节段曲度,分析这些参数在手术前后的变化。结果X线片测量显示,融合节段颈椎前高、后高及节段曲度在术后1周内A、B组在均较术前明显改善,A组分别增加(3.4±0.6)mm,(1.9±0.6)mm,(6.2±8.1)°,B组分别增加(4.1±1.6)mm,(2.2±0.8)mm,(7.1±5.3)°,两组间统计学差异无显著性(P>0.05,t=1.932,1.484,0.420),在术后2～4个月、术后5～7个月及术后1年以上的随访中,A组均有不同程度的丢失,以术后2～4个月尤著,而B组在术后长期随访中无明显丢失,均能较好维持,两组间统计学差异有显著性(P<0.05,t值为2.435～4.701。颈椎总曲度在术后1周内亦较术前明显改善,A组增加(10.4±7.7)°、B组增加(8.1±3.4)°,两组间统计差异无显著性(P>0.05,t=1.364);在术后2～4个月、术后5～7个