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1.
目的:评估分期手术治疗先天性脊柱侧凸合并脊髓纵裂和脊髓拴系患者的安全性与近期疗效。方法 :回顾性分析我院2009年1月~2014年1月收治的66例先天性脊柱侧凸合并脊髓纵裂和脊髓拴系患者的临床资料。其中男20例,女46例,年龄17.2±4.5岁(7~26岁)。5例患者术前存在下肢神经功能障碍。脊柱侧凸冠状位主弯Cobb角97.6°±23.5°(50°~165°),主弯位于颈胸段1例,胸段58例,胸腰段7例。23例同时存在矢状位后凸畸形,Cobb角89.5°±13.9°(47°~165°)。伴有Ⅰ型脊髓纵裂45例,Ⅱ型脊髓纵裂21例,均合并脊髓拴系。所有患者均行分期手术治疗:Ⅰ型脊髓纵裂组患者一期切除骨性分隔、松解脊髓拴系,Ⅱ型脊髓纵裂组患者一期松解脊髓拴系;一期术后3~4周,二期行侧凸矫形手术。结果:一期手术时间208.7±107.2min(60~505min),术中出血量297.1±192.6ml(20~2000ml);二期手术时间392.6±150.7min(196~600min),术中出血量2158.8±1158.4ml(450~6000ml)。术前存在下肢神经功能障碍的5例患者中,1例术后下肢肌力提高2级,感觉功能有所恢复;其余4例术后神经功能无明显变化。2例术前神经功能正常患者二期术中出现脊髓损伤(3.0%,2/66),其中1例术后双下肢肌力降为4级,感觉稍减退,术后1周感觉、运动功能完全恢复正常;另1例术后双下肢肌力降低至2级,双下肢及会阴部感觉减退,经脱水、激素冲击治疗及高压氧治疗,术后1个月双下肢肌力恢复至3级,术后2年随访时双下肢肌力恢复至4级,双下肢残留轻度麻木感,大小便功能正常。4例(6.1%,4/66)患者二期术后并发胸腔积液。均获得随访,随访时间12.4±3.5个月(6~24个月)。随访期间未发现椎弓根螺钉松动及断裂现象。脊柱侧凸矫形术后冠状位Cobb角为41.6°±17.8°(12°~107°),矫正率为(61.3±14.3)%;末次随访时冠状位Cobb角为43.7°±16.6°(15°~108°),丢失率为(1.9±1.1)%。术后矢状位后凸Cobb角为38.4°±11.0°(2°~78°),矫正率为(67.6±23.4)%,末次随访时矢状位Cobb角为39.7±11.2°(3°~87°),丢失率为(2.3±1.3)%。结论:分期手术治疗合并脊髓纵裂和脊髓拴系的先天性脊柱侧凸具有较高的手术安全性,并可获得较满意的矫形效果。  相似文献   

2.
目的 评估脊柱截骨治疗先天性脊柱侧凸合并脊髓纵裂畸形的安全性与近期疗效.方法 回顾性分析2008年5月至2011年5月间采用脊柱截骨手术治疗31例先天性脊柱侧凸合并脊髓纵裂患者的病历资料,29例获得随访.男11例,女18例;年龄6~26岁,平均13岁.其中合并脊髓栓系综合征7例.术前冠状位Cobb角25°~120°,平均66.5°±21.5°;冠状位顶椎偏距0~100 mm,平均(52.1±21.3)mm;冠状位躯干偏距0~40 mm,平均(12.2±13.2) mm.采用半椎体切除7例、经椎弓根截骨16例、全椎体切除6例.结果 随访8~24个月,平均18个月.术后即刻冠状位Cobb角15°~40°,平均24.4°±18.6°,平均矫正率63.3%.术后即刻冠状位顶椎偏距0~50 mm,平均(21.1±19.2) mm,平均矫正率59.5%.术后即刻冠状位躯干偏移0~28 mm,平均(5.5±10.5) mm,平均矫正率55.0%.手术前后比较差异均有统计学意义.合并脊髓栓系综合征的7例患者中3例下肢肌力恢复1~2级,1例小便控制得到改善.所有患者术后均未出现永久性神经功能恶化现象.随访期间4例患者各发生1枚螺钉断裂,均为应力集中部位.结论 先天性脊柱侧凸合并脊髓纵裂畸形,骨性纵裂近端脊柱截骨矫形可获满意疗效,对部分有脊髓栓系神经症状者有促进神经功能恢复的作用.  相似文献   

3.
目的:评价一期三柱截骨术治疗先天性脊柱侧凸合并脊髓异常患者的有效性及安全性。方法 :以2015年1月~2017年5月我院收治的62例先天性脊柱侧凸合并脊髓异常患者为研究对象,男32例,女30例,年龄4~35岁,平均15.3±8.3岁;46例具有神经症状。所有患者均行一期三柱截骨矫形术,术后随访12个月。记录手术时间、术中出血量及术后并发症发生情况;在术前、术后3个月及末次随访时,采用脊柱裂神经量表(SBNS)对患者的估神经功能进行评估,采用视觉模拟评分(VAS)评价疼痛程度,对患者进行全脊柱正侧位X线检查,测量冠状位Cobb角、矢状位后凸Cobb角、躯干偏移,计算矫正率及丢失率。结果:手术平均时间与术中平均出血量分别为565.3±140.8min、3570.6±1855.4ml;术后3个月平均冠状位Cobb角为41.7°±17.7°,平均矫正率为(62.5±13.8)%;平均矢状位后凸Cobb角为38.5°±11.2°,平均矫正率为(66.4±22.6)%;末次随访时平均冠状位Cobb角为43.7°±16.6°,平均丢失率为(1.9±1.1)%;平均矢状位后凸Cobb角为39.7°±11.3°,平均丢失率为(2.3±1.4)%;术后3个月及末次随访时的Cobb角、躯干偏移、SBNS评分及VAS疼痛评分均得到明显改善(P0.05);术前28例SBNS分级为Ⅱ级的患者恢复至Ⅰ级,9例SBNS分级为Ⅲ级的患者恢复至Ⅱ级;14例腰骶部疼痛患者、9例下肢肌力下降患者、8例大小便功能障碍患者及4例下肢细小患者得到改善;发生术后并发症8例,包括3例脑脊液漏、2例伤口感染及3例泌尿系感染。结论:一期三柱截骨术治疗先天性脊柱侧凸合并脊髓异常患者安全有效,且能促进神经功能的恢复。  相似文献   

4.
目的探讨经后路截骨联合椎弓根内固定矫形治疗僵硬性脊柱侧后凸畸形疗效。方法对26例僵硬性脊柱侧后凸畸形患者进行后路截骨、椎弓根内固定矫形。8例行后路Ponte截骨,13例行椎弓根截骨术(PSO)联合Ponte截骨,5例行全椎体切除术(VCR)。比较患者术前、术后和末次随访时Cobb角的变化及C7中垂线与骶骨中垂线距离的变化。结果患者均获得随访,时间12~60个月。侧凸Cobb角:术前30°~135°(90.7°±30.6°),术后12°~30°(18°±5.6°),矫正率为82.5%,末次随访13°~32°(20°±5.8°),丢失4.3%;后凸Cobb角:术前20°~60°(40.6°±18.5°),术后10°~26°(16.8°±6.2°),矫正率为85%,末次随访13°~30°(20.5°±7.0°),丢失3.7%;C7中垂线与骶骨中垂线距离:术前3.8~6.5(5.1±1.3)cm,术后0.3~1.3(0.7±0.3)cm,末次随访0.4~1.7(0.8±0.3)cm。所有患者未发生神经损伤等并发症,仅1例患者术后3个月出现内固定松动,经延长固定节段后骨性融合。结论术前充分的评估,选择合适的后路截骨方式,联合椎弓根内固定矫形治疗僵硬性脊柱侧弯,能有效矫正畸形和恢复脊柱冠、矢状面平衡。  相似文献   

5.
目的 :研究手术治疗先天性脊柱侧凸合并脊髓纵裂的患者的临床特点,评估其手术疗效及并发症发生情况。方法:回顾性分析2005年3月~2017年3月间我院收治并行手术治疗的先天性脊柱侧凸合并脊髓纵裂患者69例,其中女性41例,男性28例,平均年龄13.9±4.5岁(7~34岁)。所有患者术前均行全脊柱正侧位X线、CT及MRI检查,术后即刻及末次随访行全脊柱正侧位X线检查,测量影像学参数(主弯Cobb角、次弯Cobb角、主弯顶椎偏距、躯干偏移、胸椎后凸角及腰椎前凸角),分析先天性脊柱侧凸合并脊髓纵裂的影像学特点及临床表现,并评估脊柱侧凸矫形率及相关并发症[矫形率=(术前Cobb角-术后即刻Cobb角)/术前Cobb角]。结果:在69例脊髓纵裂患者中,单纯膜性纵裂50例,骨性纵裂4例,膜性合并骨性纵裂15例。合并椎板畸形38例,半椎体24例,肋骨畸形25例,37例同时存在其他椎管内畸形,椎管外畸形8例。临床表现主要有:背部毛发10例,跛行6例,腰背痛4例,截瘫2例。双下肢/双足异常8例,神经系统阳性体征20例。脊髓纵裂好发于下胸段及腰段,占72.4%(50/69),纵裂累及椎体节段平均为4.2±2.7个。所有患者中,1例在矫形前行骨嵴切除,余均未对纵裂做预防性切除,仅单纯行侧凸矫形内固定术。60例得到随访,随访率为86.9%。平均随访时间32.4±22.7个月(13~115个月)。术前主弯Cobb角平均为71.8°±29.4°,次弯Cobb角为46.4°±17.3°,胸椎后凸角为39.5°±36.1°,腰椎前凸角为50.4°±17.3°;主弯顶椎偏距为6.2±3.6cm,躯干偏移平均为2.8±3.0cm。术后即刻主弯Cobb角28.8°±21.6°,次弯Cobb角25.6°±14.5°,胸椎后凸角25.5°±19.1°,腰椎前凸角42.3°±15.4°;主弯顶椎偏距4.2±3.3cm,躯干偏移2.4±2.8cm,主弯顶椎旋转度所有患者术后即刻冠状位主弯矫形率为(59.9±22.0)%,末次随访时矫形率为(53.6±25.7)%。术后即刻与术前相比,主弯Cobb角、次弯Cobb角、胸椎后凸角、腰椎前凸角及主弯顶椎偏距均有明显统计学差异(P0.01),主弯顶椎旋转度及躯干偏移无明显统计学差异。末次随访时主弯Cobb角平均为33.3°±25.9°,次弯Cobb角为27.1°±16.9°,胸椎后凸角为25.1°±16.1°,腰椎前凸角为45.6°±17.6°;主弯顶椎偏距为4.9±6.0cm,躯干偏移平均为2.1±2.0cm,末次随访与术后相比,均无明显统计学差异(P0.05)。术后共6例出现神经系统并发症,发生率为8.7%,均为不完全神经损伤,无截瘫发生。内固定相关并发症3例,包括螺钉松动2例,内固定棒断裂1例。2例螺钉松动患者无任何临床症状,予以随访观察;1例内固定棒断裂患者手术翻修,未再次出现并发症。结论:先天性脊柱侧凸合并SCM手术治疗患者纵裂好发于下胸段及腰段,椎体畸形以混合型最多见;中下胸段肋骨畸形的伴发率最高。  相似文献   

6.
[目的]探讨大重量halo-股骨髁上牵引辅助一期后路手术治疗伴脊髓纵裂的僵硬型先天性脊柱侧凸的安全性和临床疗效。[方法]回顾性研究2011~2016年本科收治的伴脊髓纵裂的僵硬型先天性脊柱侧凸患者18例,年龄10~24岁,平均(16.33±4.61)岁;主弯位于胸段9例,胸腰段2例,腰段7例;其中分节不良10例,形成障碍2例,混合型6例;合并I型脊髓纵裂4例,II型脊髓纵裂12例,复合型2例。术前主弯冠状面Cobb角60°~113°,平均(81.28±16.25)°;凸侧侧向弯曲位Cobb角44.50°~98.00°,平均(70.31±19.35)°;柔韧性5.85%~28.66%,平均15.81%;所有患者术前均未发现神经功能异常。均采用术前大重量halo-股骨髁上牵引辅助一期后路矫形手术。[结果]手术时间240~380 min,平均(327.78±44.10) min;术中出血量640~2 100 ml,平均(1 285.56±523.52) ml。随访12~36个月,平均(20.44±8.29)个月。大重量牵引后主弯冠状面Cobb角减少至35.60°~87.50°,平均(56.38±16.35)°;后路矫形术后主弯冠状面Cobb角减少至19.10°~56.20°,平均(35.92±13.74)°;侧凸矫正率为48.19%~69.40%,平均(60.24±9.04)%;末次随访时主弯冠状面Cobb角19.50°~57.10°,平均(36.36±13.42)°,与矫形术后相比无明显丢失。术中、术后及随访时均未出现神经功能损伤表现。[结论]大重量halo-股骨髁上牵引辅助一期后路手术治疗伴脊髓纵裂的僵硬型先天性脊柱侧凸,在不切除纵隔和脊柱缩短截骨的情况下,可获得较满意的矫形效果和安全性。  相似文献   

7.
目的评价脊柱后路矫形内固定植骨融合术治疗马凡综合征合并脊柱侧凸的治疗效果。方法马凡综合征合并脊柱侧凸患者12例,进行脊柱后路矫形内固定植骨融合术,术前脊柱侧凸主弯Cobb角62°~90°(71°±6°)。结果手术时间3.4~4.8(4.2±0.4)h,出血量550~920(690±117)m l。全部患者均获随访,时间0.9~4.8年,未发生神经及其它系统并发症。术后主弯Cobb角24°~37°(29°±3°),矫正率51%~65%(59%±4%),植骨全部融合,无假关节形成及断钉、脱钩发生。结论脊柱后路矫形内固定植骨融合术治疗马凡综合征合并脊柱侧凸,对侧凸矫形疗效满意。  相似文献   

8.
目的:观察伴神经功能损害脊柱侧后凸畸形患者脊髓内移后路矫形术后神经电生理变化和功能转归。方法:2005年1月~2014年1月在我院接受脊髓内移、脊柱后路矫形内固定术治疗伴神经损害的脊柱侧后凸畸形患者14例,女6例,男8例;年龄22.0±14.5岁(6~53岁)。术前均表现为双下肢麻木,其中7例伴行走不稳;双下肢病理征均为阳性。神经功能Frankel分级:C级5例,D级9例。胸弯11例,胸腰弯3例,后凸顶椎均位于侧凸顶椎区内。术前冠状面主弯Cobb角为76.9°±33.2°(65°~100°),后凸Cobb角为71.5°±31.8°(41°~125°)。采用加拿大XLTEK肌电诱发电位仪分别于术前和术后1周检测14例患者的体感诱发电位(SEP),术中行SEP和运动诱发电位(MEP)监测。在MRI上测量顶椎区凸侧脊髓外缘至椎管内缘距离,计算脊髓内移距离。结果:术前胫后神经SEP P40的波幅与峰潜伏期为1.67±0.38μV和38.96±2.51ms,术中为1.69±0.36μV和38.15±2.14ms,术中与术前比较波幅与峰潜伏期均无显著性变化(P0.05)。术后冠状面主弯Cobb角矫正率为(50.3±20.6)%(14.5%~85%),后凸Cobb角矫正率为(39.0±17.7)%(20.8%~57.9%);顶椎区脊髓位置平均内移2.3±1.6mm(0.6~4.4mm)。术后1周时胫后神经SEP P40波幅与潜伏期为2.10±0.35μV和35.54±2.12ms,与术前比较明显改善(P0.05)。神经功能均有明显改善。结论:脊髓内移后路矫形内固定治疗伴神经损害的脊柱侧后凸畸形术后患者神经电生理指标和神经功能均明显改善。  相似文献   

9.
目的:探讨骨桥切断、凹侧松解、半椎体切除治疗儿童轻中度混合型先天性脊柱侧后凸的效果。方法:2001年1月~2013年1月对32例椎体分节障碍混合椎体形成障碍的先天性脊柱侧后凸患儿行后路半椎体切除的同时,行凹侧骨桥切断、松解,利用椎弓根钉棒系统矫形。其中男10例,女22例;年龄4~12岁(7.8±4.2岁)。侧凸Cobb角58.3°±12.5°(35°~78°),后凸Cobb角47.6°±15.6°(13°~55°),躯干偏移18.2±5.5mm(11~32mm)。畸形位于T7~L3,顶椎位于胸段11例、胸腰段13例、腰段8例。合并脊髓纵裂3例,神经根囊肿1例,脊髓拴系综合征1例。结果:手术时间230±125min(160~270min),术中出血量590±113ml(310~850ml)。术中2例置钉过程中出现椎弓根骨折,调整固定节段后完成矫形。术后1例出现单侧下肢麻木无力,予甲强龙及脱水剂治疗1周后症状缓解;2例出现脑脊液漏。术后脊柱侧凸Cobb角13.8°±7.1°(5°~28°),矫正率(76.3±9.5)%;脊柱后凸15.1°±3.9°(0~20°),矫正率(68.3±11.2)%;躯干偏移距离3.1±2.3mm(0~11.6mm)。随访18.4±12.6个月(12~60个月),末次随访时侧凸矫正率丢失(3.9±1.6)%,后凸矫正率丢失(2.3±0.9)%,无内固定松动及断裂发生。结论:对儿童轻中度混合型先天性脊柱侧后凸畸形,行后路一期半椎体切除的同时,将凹侧分节障碍的骨桥予以切断、松解,再通过椎弓根钉棒系统矫形,可获得满意的矫形效果。  相似文献   

10.
目的探讨单纯后路截骨矫形治疗先天性脊柱侧凸合并Ⅰ型脊髓纵裂畸形的安全性和临床效果。方法回顾性分析2005年3月至2015年9月收治的10例先天性脊柱侧凸合并Ⅰ型脊髓纵裂畸形患者的临床资料,均不处理骨性纵隔,单纯经后路截骨进行矫形。通过记录手术时间、术中失血量和输血量、围手术期神经功能变化及并发症来评估手术的安全性,根据手术前后脊柱侧凸冠状面Cobb角、顶椎偏距、胸廓躯干偏移和躯干平衡等客观矫形指标及脊柱侧凸研究学会(SRS)-30评分来评估手术的有效性。结果患者获得3~36个月随访(平均14.2个月)。平均手术时间、术中失血量及术中输血量分别为275.4 min、4 005.7 m L和2 800 m L;围手术期并发症包括脑脊液漏1例、胸腔积液10例、切口感染1例、下肢神经功能症状加重6例(其中5例治疗后恢复至术前水平、1例遗留永久性足下垂)。术后大体外观均显著改善;术后及末次随访时影像学测量参数均较术前明显改善(P0.05),末次随访时矫正率虽较术后即刻有所丢失,但总体矫形效果满意;末次随访SRS-30自我形象、心理健康评分以及总评分均优于术前,手术前后比较,差异有统计学意义(P0.05)。结论对于合并Ⅰ型脊髓纵裂畸形的先天性脊柱侧凸患者,采取不预先处理骨性纵隔的单纯经后路截骨治疗矫形效果满意,但具有一定的手术风险,需严格掌握适应证。  相似文献   

11.
Summary The evoked spinal cord potential elicited by direct stimulation of the cord has been used clinically to monitor cord function in the course of operations on the spine. The technique used allows measurement of a relatively large amplitude of potential, which is fairly stable against anaesthetics and related drugs, by means of a simple recording system and is sensitive enough to indicate cord damage. Continuous monitoring can easily be carried out. We have encountered no complications when using this method on 99 patients.
Résumé Le potentiel évoqué provoqué par la stimulation directe de la moelle épinière a été utilisé en clinique pour contrôler la fonction de la moelle lors des interventions sur le rachis. Cette technique permet de mesurer une assez grande amplitude de potentiel, qui est relativement stable à l'égard des anesthésiques et d'autres drogues de même type, grâce à un système simple d'enregistrement; il est suffisamment sensible pour détecter des altérations de la moelle. Une surveillance continue peut aisément être effectuée. Aucun incident n'a été rencontré chez 99 malades lors de l'utilisation de cette méthode.
  相似文献   

12.
Chronic spinal cord lesions (CSCL) which result in irreversible neurologic deficits remain one of the most devastating clinical problems. Its pathophysiological mechanism has not been fully clarified. As a crucial factor in the outcomes following traumatic spinal cord injury (SCI), the blood-spinal cord barrier (BSCB) disruption is considered as an important pathogenic factor contributing to the neurologic impairment in SCI. Vascular endothelial growth factor (VEGF) is a multirole element in the spinal cord vascular event. On one hand, VEGF administrations can result in rise of BSCB permeability in acute or sub-acute periods and even last for chronic process. On the other hand, VEGF is regarded to be correlated with angiogenesis, neurogenesis and improvement of locomotor ability. Hypoxia inducible factor-1 (HIF-1) is a primary regulator of VEGF during hypoxic conditions. Therefore, hypoxia-mediated up-regulation of VEGF may play multiple roles in the BSCB disruption and react on functional restoration of CSCL. The purpose of this article is to further explore the relationship among HIF-1, hypoxia-mediated VEGF and BSCB dysfunction, and investigate the roles of these elements on CSCL.  相似文献   

13.
Summary Experimental spinal cord transection injuries followed by spinal cord destruction and gentle resection of the destructed cord tissue necessarily lead to a gap between both of the cord stumps. For any attempts to reconstruct the cord or to bridge this gap by transplantation it may be useful to narrow or close the gap. This can be done by vertebral resection.The technique of upper lumbar vertebra resection in cats and rabbits with and without spinal cord lesion is presented. The spine is shortened by approximately 20 mm by spondylectomy. This length exceeds the 10–14 mm long gap in the spinal cord which is created by a spinal cord crush injury using haemostatic forceps and the subsequent destruction zone resection which is performed seven days later. The upper lumbar vertebra is resected by the posterior approach and the spinal cord is sufficiently exposed to perform spinal cord reconstruction experiments.  相似文献   

14.
15.
Context: Anatomical variations of the filum terminale (FT) have been described in association with split cord malformations (SCM) but they appear to be a rare finding in its absence. We report the first case in literature of a duplicated FT in a patient presenting with tethered cord syndrome (TCS) without any radiological evidence of SCM.

Findings: A 47-year-old man presented with invalidating back pain radiating to both legs. Magnetic resonance imaging revealed an intradural dorsal lipoma in a low-lying conus. Intraoperatively two distinct fibrous bands were anatomically and electrophysiologically identified as the FT and both were sectioned. The diagnosis of FT was confirmed for both specimens by histology.

Conclusion: In absence of SCM, a duplicated FT has not been previously described as a cause of TCS. It may be a cause of treatment failure for TCS if unrecognized on preoperative imaging and during surgery if one filum remains intact. We highlight the importance of a meticulous cauda equina dissection supported by intraoperative nerve stimulation to identify this rare anomaly. We hypothesize that this entity may represent a variant of SCM involving the caudal neural tube but which requires further validation at an embryological level.  相似文献   


16.
内皮素与脊髓损伤后血脊屏障损害的关系   总被引:2,自引:1,他引:1  
目的:阐明内皮素(ET)与脊髓损伤(SCI)后血脊屏障损害的关系,为临床治疗SCI提供指导。方法:SD大鼠24只,分为4组,即生理盐水组、ET-1组、损伤+生理盐水组和损伤+PD145065组。实验一:无损伤组分别于鞘内注射生理盐8水或ET-1。实验二:压迫法致伤脊髓(50g,1min),分别于伤前10min鞘内注射生理盐水或非选择性ET受体拮抗PD145065。伊文思兰(EB)定量法评价血脊屏障  相似文献   

17.
精索脂肪瘤是腹膜外脂肪经腹股沟内环突出形成的真性脂肪瘤.发生率一般在20%~30%.常由腹膜外脂肪从深环中脱出延续而造成,分叶状的后腹膜脂肪进入深环使其扩张,从而导致腹股沟疝与精索脂肪瘤的形成.BMI越高精索脂肪瘤越容易发生.同时也发现精索脂肪瘤在Ny-bus Type Ⅱ及Ⅲb型的患者存在更高的发生率,说明了精索脂肪瘤的发生与疝的类型有关系,疝越大越容易发生.精索脂肪瘤的术前诊断不易,其临床表现与腹股沟疝及其相似.超声检查是一种安全而有效的方法,对诊断腹股沟疝和脂肪瘤的确诊率高达92%.只要腹膜外脂肪组织疝入腹股沟管,在手术中尽可能的将脂肪瘤切除,并按腹股沟疝行修复手术.  相似文献   

18.
扩大半椎板切除术治疗颈脊髓损伤   总被引:12,自引:1,他引:11  
Xu S  Liu S  Sun T  Liu Z 《中华外科杂志》1999,37(10):607-609,I037
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.  相似文献   

19.
Abstract

Objective

To compare and describe demographic characteristics, clinical, and survival outcomes in patients admitted for inpatient rehabilitation following malignant spinal cord compression (MSCC) or other causes of non-traumatic spinal cord injury (NT-SCI).

Design

A retrospective cohort design was employed, using data retrieved from administrative databases.

Setting

Rehabilitation facilities or designated rehabilitation beds in Ontario, Canada, from April 2007 to March 2011.

Participants

Patients with incident diagnoses of MSCC (N = 143) or NT-SCI (N = 1,274) admitted for inpatient rehabilitation.

Outcome measures

Demographic, impairment, functional outcome (as defined by the Functional Independence Measure (FIM)), discharge, healthcare utilization, survival, and tumor characteristics.

Results

There was a significant improvement in the FIM from admission to discharge (mean change 20.1 ± 14.3, <0.001) in the MSCC cohort. NT-SCI patients demonstrated a higher FIM efficiency (1.2 ± 1.7 vs. 0.8 ± 0.8, <0.001) and higher total (24.0 ± 14.4 vs. 20.1 ± 14.3, <0.001) FIM gains relative to MSCC cases. However, there were no differences between the MSCC and NT-SCI cohorts in length of stay (34.6 ± 30.3 vs. 37.5 ± 35.2, P = 0.8) or discharge FIM (100.7 ± 19.6 vs. 103.3 ± 18.1, P = 0.1). Three-month, 1-year, and 3-year survival rates in the MSCC and NT-SCI cohorts were 76.2% vs. 97.6%, 46.2% vs. 93.7%, and 27.3% vs. 86.7%, respectively. The majority (65.0%) of patients with MSCC was discharged home and met their rehabilitation goals (75.5%) at comparable rates to patients with NT-SCI (69.7 and 81.3%).

Conclusion

Despite compromised survival, patients with MSCC make clinically significant functional gains and exhibit favorable discharge outcomes following inpatient rehabilitation. Current administrative data suggests the design and scope of inpatient rehabilitation services should reflect the unique survival-related prognostic factors in patients with MSCC.  相似文献   

20.
We report a case of solitary neurofibroma of the spermatic cord. Such benign tumors arise from perineural and Schwann cells and may be located in various parts of the body, but are rarely observed in the spermatic cord. No clinical or laboratorial manifestations of von Recklinghausen disease (Neurofibromatosis) were identified. Distinct criteria have been established for a diagnosis of von Recklinghausen disease, so that a solitary neurofibroma may not represent this complex. Only a little number of solitary neurofibromas of the spermatic cord are reported in the literature.  相似文献   

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