球囊扩张椎体后凸成形术治疗老年骨质疏松性脊柱骨折所致腰背痛

目的探讨球囊扩张椎体后凸成形术治疗老年性骨质疏松性脊柱骨折所致腰背痛的早期疗效和安全性。方法自2003年8月-2005年6月采用球囊扩张椎体后凸成形术(kyphoplasty)治疗骨质疏松性脊柱压缩性骨折10例患者腰背部疼痛,无神经症状和体征。在C臂X线机透视下,采用经皮穿刺经两侧椎弓根在病椎内置入2枚或1枚球囊扩张椎体后使塌陷椎体复位后,将聚甲基丙浠酸甲酯(PMMA)灌注入球囊扩张后所形成的空腔内。观察术后疼痛的改善程度,骨折复位情况及并发症。结果10例患者手术经过顺利,术后疼痛均有明显缓解或消失,术后24h小时均可下地活动,X线片示骨折后突畸形平均矫正16°(12°～30°),无一例出现并发症。结论球囊扩张椎体后凸成形术是目前有价值的治疗骨质疏松所致腰背痛微创治疗技术,具有创伤少、出血少、止痛效果好、安全性高,并能即刻加固病椎,增加脊柱稳定性。     

球囊扩张椎体后凸成形术治疗骨质疏松性脊柱压缩性骨折

目的探讨球囊扩张椎体后凸成形术治疗骨质疏松性脊柱压缩性骨折的疗效和安全性。方法自2003年1月~2004年10月采用球囊扩张椎体后凸成形术(kyphoplasty)治疗骨质疏松性脊柱压缩性骨折18例19椎,均为新鲜骨折,腰背部疼痛剧烈,无神经症状和体征。在C型臂X线机透视下,采用经皮穿刺经两侧椎弓根在伤椎内置入2枚球囊扩张后使塌陷椎体复位后,将含钡骨水泥灌注入球囊扩张后所形成的空腔内。观察术后疼痛的改善程度,骨折复位情况及并发症。结果18例手术经过顺利,术后疼痛均有明显缓解或消失,术后24h均可下地活动,X线片示骨折后突畸形平均矫正14°(11°~17°),3例有少量骨水泥渗漏至椎体两侧,无临床症状;2例术后出现不全性肠梗阻,经非手术治疗而治愈,无其他严重并发症。结论球囊扩张椎体后凸成形术治疗骨质疏松性脊柱压缩性骨折具有创伤小、止痛效果好、安全性高,并能恢复脊柱的稳定性和正常序列。     

脊柱压缩骨折微创治疗的初步报告

目的探讨椎体成形术及椎体后凸成形术治疗脊柱压缩骨折(vertebral compression fractures,VCF)的初步疗效和安全性. 方法 2000年5月～2002年10月分别采用椎体成形术(vertebroplasty,VP)及椎体后凸成形术(kyphoplasty,KP)治疗脊柱压缩骨折43例69椎,分别为椎体后壁完整的疼痛性骨质疏松性压缩骨折及椎体血管瘤导致的椎体压缩骨折.先经双侧椎弓根或椎弓根旁置入导针或可扩张球囊使骨折塌陷椎体复位,然后骨水泥充填椎体,观察术后症状改善及骨折复位情况,分析并发症. 结果 43例手术均顺利,疼痛于术后48 h内均明显缓解.VP组椎体高度无明显改变,KP组骨折椎体前缘和中部高度的丢失分别由术前的(13.6±2.3)mm和(9.2±1.4)mm减少至(4.7±1.5)mm和(3.4±1.1)mm(t=2.85,3.27;P<0.01),后凸畸形Cobb角由术前的24.4°±5.2°矫正至9.5°±4.7°(t=3.21,P<0.01).1例一侧术中穿刺管内出现脑脊液,该侧当即停止手术.未发现其他严重并发症.随访3～28个月,平均13个月,SF-36评分由术前(187.5±10.3)分恢复至术后(376.4±15.9)分(t=4.36,P<0.01). 结论椎体成形术及椎体后凸成形术可迅速、有效缓解疼痛,改善功能,椎体后凸成形术可更有效地恢复脊柱序列.     

球囊扩张椎体成形术联合降钙素治疗老年骨质疏松性椎体骨折的疗效

目的回顾性分析球囊扩张椎体后凸成形术联合降钙素治疗骨质疏松性椎体骨折的疗效。方法 2007年2月～2010年1月,对25例35个椎体发生骨质疏松性椎体骨折患者行球囊扩张椎体后凸成形术联合降钙素综合治疗。术中在透视机监视下采用单侧椎弓根穿刺,置入1枚可扩张球囊使骨折塌陷椎体复位,灌注骨水泥充填由球囊扩张所形成的椎体内空腔。术后每天静脉注射鲑鱼降钙素,通过观察患者术后症状改善及骨折复位情况来评估其疗效。结果所有患者随访6～32个月,平均（21.3±0.2）个月。全部患者均顺利完成手术,无症状性并发症发生。术后疼痛明显减轻或消失。术后椎体高度平均恢复率59.5%。结论球囊扩张椎体后凸成形术治疗骨质疏松性椎体骨折可有效缓解疼痛、改善功能及恢复脊柱序列,联合降钙素的应用能有效缓解骨质疏松性椎体压缩骨折引起的疼痛,是治疗骨质疏松性椎体骨折的较好微创方法之一。     

球囊扩张椎体后凸成形术治疗多节段骨质疏松性胸腰椎压缩骨折

目的探讨应用球囊扩张椎体后凸成形术（PKP）治疗多节段老年骨质疏松性脊柱骨折的疗效和安全性。方法自2005年1月至2007年10月,采用球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩性骨折28例67个病椎,均经单侧椎弓根置入可扩张球囊使骨折塌陷椎体复位,然后使用骨水泥充填椎体,观察术后症状改善及骨折复位情况。结果28例手术均顺利,疼痛于术后24h内均明显缓解,术后无脊髓神经根受损表现,X射线片复查,显示病椎高度明显恢复,后凸畸形大部分矫正。结论经皮球囊扩张椎体后凸成形术治疗多节段性老年骨质疏松脊柱骨折安全有效。     

椎体后凸成形术治疗骨质疏松性椎体压缩骨折

目的探讨单球囊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8例17椎,均为新鲜骨折,腰背部疼痛剧烈,无神经症状及体征。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。在X线C形臂透视下,采用经皮经椎弓根穿刺,在伤椎内先后植入同一枚球囊,扩张使椎体复位后,将含钡骨水泥注入椎体扩张所形成的空腔内。结果所有患者术后疼痛均明显缓解或消失。平均椎体前缘高度恢复50·2%±12·1%。平均灌注骨水泥5·8mL(4·5~7·6mL),1例椎体前缘发生骨水泥渗漏,未引起临床症状。所有患者均获得随访,随访时间6~48个月,平均14·5个月,未发现与手术有关的并发症出现。结论单球囊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,疗效满意。     

椎体后凸成形术治疗骨质疏松性脊柱压缩骨折

[目的]分析椎体后凸成形术治疗骨质疏松性椎体压缩骨折的临床和影像学结果,评价其临床效果。[方法]本组43例骨质疏松性椎体压缩骨折均接受经皮椎体球囊扩张后凸成形术。其中男19例,女24例;年龄56~85岁,平均68·2岁。本组共61个椎体骨折,其中单椎体26例,两椎体骨折11例,三椎体骨折4例,四椎体骨折2例。椎体骨折部位T7~L5。术后对患者的疼痛、日常功能以及影像学结果进行了分析。[结果]所有患者随访1a以上,平均18·8个月(12~36个月)。平均VAS评分由术前8·6到术后2·3和最终随访2·7(P<0·001),Oswestry评分由术前55到术后30和最终随访35(P<0·01)。手术椎体前、中柱平均高度由术前的12·20mm到术后的25·38mm和最终随访26·36mm。脊柱矢状位后凸畸形改善平均9·9°(4·3~22°),随访丢失平均1·6°(0·8~1·7°)。4例发生骨水泥渗漏,但无严重并发症发生。最终随访时有3例患者发生3个临近节段椎体压缩骨折。[结论]球囊扩张椎体后凸成形术可有效恢复骨质疏松性骨折椎体的高度、迅速缓解疼痛、改善病人的功能,明显减少骨水泥的渗漏率,是一种安全、有效的治疗方法。     

过伸复位结合椎体后凸成形术治疗骨质疏松性椎体压缩骨折

目的探讨过伸复位结合椎体后凸成形术治疗骨质疏松性椎体压缩骨折的临床疗效。方法对65例骨质疏松性椎体压缩骨折患者(76个椎体)在DSA透视下行过伸复位结合经皮经椎弓根球囊扩张注入骨水泥,行椎体后凸成形术(PKP),对复位前、体位复位后、PKP术后1 d的后凸角和疼痛评分等进行评估。结果术后54例腰背部疼痛消失,11例疼痛明显减轻;未出现神经系统损伤及肺栓塞等并发症。患者均获随访,时间1～10(5±2.3)个月,腰背痛症状均无复发。X线片示62例椎体高度未丢失,3例有邻近椎体再骨折发生。术后后凸角、VAS评分较术前均有明显改善(P<0.05)。结论过伸复位结合经皮椎体后凸成形术具有微创、安全、临床疗效良好的优点。     

低压力应用单一球囊治疗多椎体骨质疏松性脊柱压缩骨折

目的探讨低压力应用单一球囊治疗多个椎体骨质疏松性脊柱压缩骨折的疗效。方法共治疗13例患者37个椎体,均为女性,年龄65～79岁,平均72.3岁。均为骨质疏松性脊柱压缩骨折,压缩骨折椎体后壁均完整。在C型臂X线机引导下行单一球囊多椎体后凸成形术。结果13例手术顺利完成。椎体前缘、中部及后缘平均高度分别由术前的(1.9±0.5)cm,(1.5±0.5)cm,(2.6±0.5)cm增至术后的(2.1±0.4)cm,(2.2±0.4)cm,(2.8±0.5)cm,椎体前缘、中部高度差异有显著统计学意义,P值均小于0.01。Cobb角由术前的(31.3±14.1)°矫正至术后的(24.8±11.3)°。术后平均随访17.3个月,患者疼痛均较术前改善或消失,无临床并发症发生。结论通过降低球囊扩张压力,避免了球囊破损,为患者减少了经济负担。同时,骨水泥填充量相应减小,减少了骨水泥渗漏,又可以避免因大幅度提高患椎弹性模量和刚度造成相邻椎体压缩骨折。     

双侧穿刺单球囊扩张椎体成形术治疗胸腰椎骨折疗效观察

目的探讨经皮双侧椎弓根穿刺单球囊扩张椎体后凸成形术治疗老年骨质疏松性骨折的临床疗效。方法回顾性分析2011年1月至2013年6月,采用经皮双侧椎弓根穿刺单球囊扩张椎体后凸成形术治疗老年骨质疏松性胸腰椎骨折28例临床疗效,观察患者手术前后疼痛视觉模拟评分(visual analogue scale,VAS)、椎体前柱高度、Cobb角及活动能力评分。结果全部病例均顺利完成手术,无并发症发生,28例均获得随访至少1年。术后2 d及末次随访结果提示所有患者术后疼痛明显减轻,椎体高度、Cobb角及行动能力均取得明显改善(P0.01)。结论经皮双侧椎弓根穿刺单球囊扩张椎体后凸成形术治疗老年骨质疏松骨折可有效缓解疼痛,恢复椎体高度,纠正脊柱后凸畸形,改善生活质量,取得满意的临床疗效,同时手术中只使用一个球囊,可以有效减轻患者的经济负担。     

Roentgenographic and biomechanical analysis of lumbar fusions: a canine model

An animal model of anterior and posterior column instability was developed to allow in vivo observation of bone remodeling and arthrodesis after spinal instrumentation. Various combinations of spinal fusions and instrumentation procedures were performed after an initial anterior and posterior destabilizing lesion was created at the L5-L6 vertebral levels in 35 adult beagles. After 6 months of postoperative observation, there was improved probability of achieving a spinal fusion if spinal instrumentation had been used. All biomechanical testing was performed after removal of instrumentation to test the inherent stiffnesses and quality of the spinal fusions. The fusions performed in conjunction with instrumentation (group V = Harrington instrumentation and posterolateral fusion; group VI = Luque instrumentation and posterolateral fusion) demonstrated the greatest axial rotation stiffnesses (group V, p less than .05); axial compressive stiffness (group V, p less than .05); and flexural stiffness (group VI, p less than .05). The results show that a spinal fusion can be more reliably achieved and will be more rigid if it is accompanied by spinal instrumentation.     

Comparison of sprotte and Quincke needles with respect to spinal fluid leakage using artificial spinal cord

Purpose This research investigated whether the Sprotte needle causes less leakage of CSF than the Quincke needle in the artificial spinal cord. Methods The changes in intradural pressure, extradural pressure, and leaked volume of CSF were evaluated following puncture with Sprotte and Quincke needles in the artificial spinal cord. Results The decrease in intradural pressure was 9.7±1.8 mm H₂O with the Sprotte needle and 20.5±2.7 mm H₂O with the Quincke needle (P<0.05). The volume of leakage of artificial CSF was 2.0±0.3 ml with the Sprotte needle and 3.3 ±0.3 ml with the Quincke needle (P<0.01). The extradural pressure increase was 166.1±8.2 mm H₂O with the Sprotte needle and 186.8±13.2 mm H₂O with the Quincke needle (P<0.05). Conclusion The Sprotte needle produces less CSF leakage than the Quincke needle.     

多椎体结核内固定与非内固定疗效的比较

目的　探讨多椎体结核内固定与非内固定疗效的差异 ,比较二者的优缺点。方法　总结 1990年～ 2 0 0 1年采用脊柱前路病灶清除植骨术与同时用饶氏椎体钉、Ventrofix、Z -Plate钢板、USS等器械内固定治疗胸腰椎结核病人共 12 4例。其中非内固定 6 8例 ,内固定 5 6例。观察术后植骨融合、神经恢复、畸形纠正情况及治愈率。结果　经平均 2 5年的随访证实 ,内固定植骨融合速度快于非内固定组 ,有显著性差异 ;神经功能Frankel分级二组全部得到改善 ;畸形纠正内固定组后弓角较术前平均改进 2 9°、非内固定组平均改进 5°,有显著性差异。内固定组治愈率为 10 0 % ,非内固定组治愈率为 87% ,有显著性差异。结论　脊柱结核内固定可早期重建脊柱稳定性并加速植骨融合 ;有明显改善畸形的作用 ;减少结核复发 ,在治疗多椎体结核中有重要意义     

A thoracic and lumbar spine injury severity classification based on neurologic function grade, spinal canal deformity, and spinal biomechanical stability

BACKGROUND CONTEXT: Current well regarded thoracic and lumbar spine injury classifications use mechanistic and anatomical categories, which do not directly rely on quantifiable management parameters. Their clinical usefulness is not optimal. PURPOSE: Formulate an injury severity based classification. STUDY DESIGN/SETTING: This retrospective investigation studied patients who suffered thoracic and lumbar spine injuries, and examined the following three quantifiable parameters: 1) neurologic function grade; 2) spinal canal deformity; 3) biomechanical stability. These parameters are the primary clinical indications for management decisions. PATIENT SAMPLE: One hundred twenty-six consecutive patients with spinal trauma admitted to a level 1 tertiary trauma center from January 1997 to November 2005 were enrolled in this study. OUTCOME MEASURES: Spine injury severity was independently scored on three parameters: 1) neurologic function impairment grade according to the modified Frankel grading method and the American Spinal Injury Association (ASIA) function scale; 2) spinal canal deformity from translation and intrusion, measured as percent canal cross-sectional area compromise; 3) failure of five possible biomechanical functions in Denis's three anatomic columns, and a sixth group of unstable deformities. All three columns contribute to tensile function. Only the anterior and middle columns provide compression load-bearing function. A combination of three or more column biomechanical function failure or an unstable deformity renders the injury unstable. METHODS: Five fellowship-trained spine surgeons from one institution took part in the study. Hospital medical records, including admission history and physical examination, discharge summary, and operative report (if surgery was performed), were examined for neurologic deficit. Plain radiographs, computed tomographic scans and magnetic resonance imaging were assessed for canal compromise and biomechanical function status. RESULTS: Injuries were located from T3 to L5, 58% of which were at the thoracolumbar junction (T11-L2). Neurologic impairment occurred in 45% (57/126) of patients, with 19 complete paraplegias (Frankel grade A). The average spinal canal cross-sectional area compromise was 56.1% in neurologically impaired and 14.2% for patients who where neurologically intact. The number of tensile element failure patients in neurologically impaired versus intact are as follow: tri-columns 22/4; two columns 16/8; one column 11/17; all columns intact 8/40. Load-bearing element failed in 55/57 neurologically impaired and 63/69 intact patients. Sixty-seven patients had spinal reconstructive surgery. Their average instability profile score was 4.4 out of 6, and canal compromise score was 3.3 out of 5. CONCLUSIONS: A clinically useful thoracic and lumbar spine injury classification should be based on parameters that are the primary indications for management decisions. The same parameters should be injury severity quantifiable as to guide treatment. In this study we introduced spinal canal deformity and column biomechanical functions as quantifiable parameters in thoracic and lumbar injury severity classification. Validation of this method is beyond the scope of this preliminary study.     

Surgical decompression: a life-saving procedure for an extensive spinal epidural abscess

Extensive spinal epidural abscesses (SEAs) carry a high mortality rate. Traditionally they are treated non-operatively with longterm antibiotics and/or surgical decompression, but there is a continuing debate as to whether they should be managed by emergency surgical decompression. However, such decisions are made in the light of the clinical setting. We report the successful management of a female patient who presented with features of upper cervical cord compression and later developed septic shock and multisystem failure. Surgical decompression of the cervical spine and irrigation of the epidural space with a paediatric catheter was performed followed by tricortical strut grafting and plating. At review, 36 weeks after surgery, the patient remained asymptomatic, having made full neurological recovery. The purpose of this report is to highlight the importance of emergency surgical intervention for extensive SEA in the presence of progressive neurological loss associated with multisystem failure.     

Extradural spinal meningioma: case report

Objectives

We report a case of purely extradural spinal meningioma and discuss the potential pitfalls in differential diagnosis.

Background

Spinal meningiomas account for 20–30% of all spinal neoplasms. Epidural meningiomas are infrequent intraspinal tumors that can be easily confused with malignant neoplasms or spinal schwannomas.

Case

A 62-year-old man with a previous history of malignant disease presented with back pain and weakness of the lower limbs. Magnetic resonance imaging revealed a well-enhanced T4 intraspinal lesion. The intraoperative histological examination showed a meningioma (confirmed by postoperative examination). Opening the dura mater confirmed the purely epidural location of the lesion. The postoperative course was uneventful with no recurrence 12 months after surgery.

Conclusion

Purely extradural spinal meningiomas can mimic metastatic tumors or schwannomas. Intraoperative histology is mandatory for optimal surgical decision making.     

扩大半椎板切除术治疗颈脊髓损伤

OBJECTIVE: To treat cervical spinal cord injury (SCI) accompanied with narrowing spinal canal by expanded hemilaminectomy. METHODS: From 1995 January to 1998 April 51 patients of cervical SCI were treated by expanded hemilaminectomy. Spinal injury classified in to 3 types: no fracture-dislocation (39 patients) fracture dislocation at the lower cervical spine (11), and burst fracture (1). The types of SCI included central cord injury (18 patients) incomplete cord injury (19), and complete cord injury (14). MR imaging in 23 patients showed degenerative changes with normal intensity of the cord in 14 patients, multiple level hyperintensity in 3, cystic changes in 3, myelomalasia in 3, and cord brocken in 1. Expanded hemilaminectomy was performed in 24 hours in 3 patients, in 48 hours in 9, in one week in 2, after one week in 35, and after one year in 2. The left or right laminae were removed from C(7) to C(3) in 42 patients, C(3) - T(1) in 3, C(2) - C(7) in 2, C(3) - C(6) in 3 and C(4) - C(7) in 3. Hemilaminectomy was expanded lateral to the inner of apophyseal joint and medial to the inner lamina beneath the spinal process. RESULTS: Follow-up lasted for 1 year and 7 months. Six patients with complete cord injury had of the no recovery lower extremity but recovery of the brachialis and extensor radial longus. 12 patients of central cord injury had full recovery except intrinsic muscles of the hand (5). They operated were on 2 weeks after injury. 17 patients of incomplete cord injury recovered to Frankel IV. CONCLUSIONS: Expanded hemilaminectomy is indicated for patients of cervical SCI with narrowing spinal canal or without fracture dislocation. Best results can be obtained in patients of central cord injury, and incomplete cord injury. Even in complete cord injury, 1 - 2 forearm muscle may recover (24.8%), securing a pinch grip reconstruction.     

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     

胸腰椎肿瘤全脊椎切除术后的重建方式

目的:探讨胸腰椎肿瘤全脊椎切除术后脊柱稳定性的重建方式。方法:1993￣2003年我院治疗各类胸腰椎(T5￣L5)肿瘤患者72例,其中全脊椎切除、随访2年以上、没有肿瘤复发和转移且有完整影像学资料者12例,骨巨细胞瘤9例,单发浆细胞性骨髓瘤2例,非何杰金氏淋巴瘤1例。一期前后路联合全脊椎切除11例,次全脊椎切除1例,以5种不同方式重建,分别为前路内固定加后路短节段经椎弓根内固定(ASP)5例、前路内固定加后路多节段Luque环内固定(AMP)4例、单纯后路短节段经椎弓根内固定(SP)1例、单纯后路多节段经椎弓根内固定(MP)1例、单纯前路内固定(A)1例。观察术前、术后即刻及末次随访时矢状面Cobb角度变化、植骨融合情况、有无植骨骨折及下沉等并发症。结果:随访2.5￣13年,平均6.6年。ASP方式重建的5例患者矢状面Cobb角丢失0°～7°,平均2.4°,植骨全部融合,无植骨骨折,1例因术中损伤终板而出现人工椎体轻度下沉。AMP方式重建的4例患者矢状面Cobb角丢失0°～9°,平均5°,植骨全部融合,无植骨骨折或下沉;其中1例术后1.5年植骨融合后取出后方固定,仅保留前方固定,出现植骨骨折及后凸畸形。SP或MP方式重建的2例患者矢状面Cobb角分别丢失12°和13°,植骨块均骨折。次全脊椎切除A方式重建的1例患者矢状面Cobb角无丢失,植骨融合且无植骨骨折及下沉。结论:本组病例较少,但初步可以看出ASP和AMP是全脊椎切除后坚强的重建方式,能够使植骨顺利融合,防止Cobb角度丢失。但ASP能够减少固定节段、保留运动单元,是更好的固定方式。SP和A不宜单独应用于全脊椎切除后稳定性重建。     

Spontaneous spinal epidural hematomas: is the role of dural arteriovenous malformations underestimated?

Two recent observations of spinal epidural hematomas (SEH) are presented: one of them was associated with iatrogenic coagulopathy, the other, apparently spontaneous, required reoperation for early recurrence and was finally attributed to ruptured epidural arteriovenous malformation missed during the first procedure. Both patients underwent complete recovery. Although modern neuroimaging provides quick, noninvasive, and sensitive assessment of spinal epidural bleeding, we believe that preoperative spinal angiography is indicated in spontaneous SEH with subacute clinical course. Demonstration of underlying vascular anomaly would allow better surgical planning, complete obliteration of abnormal vessels, and prevention of recurrences. Essential epidemiological, pathogenetical, and clinical aspects of SEH are reviewed.