颈五神经根麻痹

颈5神经根麻痹是颈椎病术后的常见并发症,是指颈椎管减压术后在脊髓原有症状没有加重时所发生的三角肌和（或）肱二头肌瘫痪,其发生与术后脊髓症状的改善无关,却给患者带来巨大的精神心理压力,影响了手术的综合疗效。神经根麻痹并非只见于后路手术,前路术后也有该并发症的相关报道,Sakaura等嘲回顾文献,统计得出颈椎术后神经根麻痹的发生率为4．6％,其中前路为4．3％,     

一期前后联合入路脊椎全切和椎体重建治疗颈椎肿瘤——附二例报告

累及椎体及附件的颈椎恶性肿瘤,由于椎动脉穿行于横突孔内,肿瘤位置深在,手术风险较大,围手术期并发症多,所以手术治疗棘手。本文介绍我科从2009年10月到2011年1月收治的2例累及椎体和附件颈椎肿瘤的患者,并对该部位肿瘤进行一期前后联合人路脊椎全切加重建,现报道如下。     

颈椎前路术后吞咽困难的危险因素分析

正颈椎前路手术入路自从1958年被Smith和Robinson报道以来~([1]),因其安全有效,成为目前治疗各类颈椎疾患(创伤、退行性变、肿瘤、炎症等)最常用的手术方式。随着临床报道逐渐增加,吞咽困难成为颈椎前路术后常见的并发症之一,文献报道其发生率在1.7%～79.0%之间~([2-11]),甚至有部分患者产生长期吞咽困难或者在术后早期发生严重吞咽困难。面对如此之高的发生率,了解其危险因素并     

颈椎前路术术后吞咽困难的预防措施

正颈椎前路手术入路(anterior cervical spine surgery,ACSS)是目前治疗各类颈椎疾患(创伤、退行性变、肿瘤等)最常用的手术方式,而吞咽困难是ACSS术后最常见的并发症之一,大部分文献报道其发生率在1.7%~79%之间~([1-10]),甚至有文献报道其术后早期发生率高达88.8%~([11])。面对如此之高的发生率,如何有效预防ACSS术     

椎管狭窄症的相关研究

正椎管狭窄既可以是自然退变的"内源性"因素引起,又可以是发育、创伤、感染、肿瘤等"外源性"因素引起,但终究是影响神经功能的正常运行,按照发病部位来说,颈椎管狭窄与腰椎管狭窄在临床诊疗中最为常见,发病率也最高,尤以颈椎管狭窄危害性最大且相关的并发症、手术相关问题解释不清,其中颈性眩晕因其临床症状复杂、致病机制不明确、诊断标准模糊、涉及理论众多,近年来一直难有统一的认识,这也对疾病的成因解释造成了很大困难,特别是伴有某些常见症状的颈椎管狭窄疾     

合并颈椎病的腰椎管狭窄症的两种手术方法的疗效比较

目的探讨合并颈椎病的腰椎管狭窄症手术方法的选择及疗效。方法2004年3月至2006年5月,共治疗56例合并颈椎病的腰椎管狭窄症患者,男32例,女24例,平均年龄59岁。A组24例仅行腰椎手术;B组32例在一次麻醉下对颈椎和腰椎进行一期手术,观察所有病例手术前、后及最后随访时的颈、腰椎JOA评分,分析手术并发症,以评价手术疗效。结果平均随访38个月,A组平均手术时间2．1h,出血量350ml,术后有4例需行颈椎二期手术。术前、术后及最后随访时的腰椎JOA评分分别为6．3±2．2,11．8±1．4和11．3±1．8,优良率为79．2％,而颈椎JOA评分较术前下降。B组平均手术时间5．2h,出血量1100ml,术前、术后及最后随访时的颈椎JOA评分分别为7．5±2．1,12．9±1．6和12．1±1．4,腰椎JOA评分分别为6．7±2．5,12．8±1．3和12．1±1．6,优良率为87．5％。结论术前全面评估患者的临床症状,选择合适的手术方法,合并颈椎病的腰椎管狭窄症的治疗可取得较好的临床效果。     

颈椎后路手术术后C_5神经根麻痹的预防措施

正颈椎后路手术是治疗颈椎病和颈椎后纵韧带骨化症的常用手术方法之一,其中最常见的术式包括两种:颈椎管扩大成形术(laminoplasty)和颈椎椎板切除减压融合术(laminectomy and fusion)。循证医学证实,这两种术式都可以获得较好的临床疗效,但有部分患者却在术后出现C_5神经根麻痹,导致肢体无力、麻木、疼痛等。根据文献报道,颈椎后路减压术后C_5神经根麻痹的发生率约为5.8%(1.4%～18.4%)~([1])。然而,目前     

单节段与双节段颈椎前路椎间盘切除融合术后佩戴颈托实用性的研究进展

正颈椎病是当今社会的常见病、多发病。颈椎前路椎间盘切除融合术 (anterior cervical discectomy and fusion,ACDF) 是一种治疗颈椎病的手术技术,自 1954 年 Smith 和 Robinson 进行第一例颈椎前路手术,ACDF 术已经经过 60 余年的发展,适用于各类颈椎疾患,通过减压和融合,显著改善患者预后,可以令人满意地缓解患者的症状,     

转移性颈椎肿瘤手术治疗

转移性颈椎肿瘤较少见,病人表现颈肩臂疼痛,早期诊断比较困难。本文报道6例,自1980年1月至1985年12月间,原发癌部位:肝脏2例,肺部1例,3例未找到原发癌。病理检查为转移性腺癌。5例作了颈前路肿瘤椎体切除减压手术,术后疼痛均得到缓解或消失。提出了手术目的:1、缓解或消除患者疼痛。2、维持颈椎在力学上的稳定性。3、在可能范围内根除肿瘤。4、组织学检查能提供线索,明确转移性质。     

侵犯颈椎的头颈部肿块15例外科治疗的临床分析

目的：探讨侵犯颈椎的头颈部肿块的诊断与外科治疗。方法回顾性分析15例侵犯颈椎的头颈部肿块患者的临床资料,总结侵犯颈椎的头颈部肿块外科治疗的诊疗特点。结果15例患者手术成功,术后临床症状明显缓解,3～6个月复查均未见复发,颈椎稳定性可。结论对于需行手术治疗的侵犯颈椎的头颈部肿块,临床上多以肿块颈外侧入路为主;同时要注意保护椎动脉、神经根和颈髓,术前要充分评估颈椎的稳定性,必要时重建和稳定颈椎,防止神经功能恶化。     

红外线治疗颈腰椎术后切口脂肪液化的疗效观察

目的 观察红外线照射治疗对颈腰椎后路术后脂肪液化切口愈合的效果,探讨红外线照射在治疗颈腰椎术后切口脂肪液化中的作用.方法 2008年8月至2010年9月颈腰椎后路术后脂肪液化患者35例,随机分为观察组18例,对照组17例.观察组使用红外线治疗仪照射发生脂肪液化的切口,1次/d,时间为20min.将切口愈合的时间与单纯清洁换药组进行对照.结果 红外线照射治疗组切口愈合时间6.17±0.43d,明显少于对照组8.47±0.43d (P＜0.01).结论 红外线照射治疗能明显促进颈腰椎术后脂肪液化切口的愈合,该方法不失为一种治疗颈腰椎术后切口脂肪液化的较好方法.     

牵引复位联合前路减压内固定治疗低位颈椎骨折脱位的疗效分析

目的探讨牵引复位联合前路减压内固定治疗低位颈椎骨折脱位的疗效。方法对2007年10月至2010年10月22例低位颈椎骨折脱位患者,第一步在局部麻醉下行颅骨牵引术,第二步在牵引复位情况下,行前路减压内固定术。结果该组病例术后随访12个月以上,X线片显示骨折脱位均复位,颈椎的正常序列及生理弧度恢复,植骨全部融合,无内固定断裂及松动。按Frantgkel分级,显效f降低2级）6例,有效（降低1级）13例,无效3例。结论在颈椎牵引复位的基础上行前路减压植骨融合内固定是治疗低位颈椎骨折脱位的有效方法。     

经皮完全内镜下脊柱手术技术的发展与现状

现代经皮内镜下脊柱手术技术的发展是建立在Yeung发明的YESS （ yeung endoscopic spine system ）脊柱内镜系统及YESS技术基础之上的。Ruetten，Hoogland等在YESS脊柱内镜系统基础上进行改进，并提出完全内镜技术（ full-endoscopic technique ）及TESSYS （ transforaminal endoscopic surgical system ）等概念。但这些脊柱内镜系统都是使用带工作通道的硬杆状内镜在持续生理盐水灌洗下进行的微创脊柱手术，只是手术技术上不断改进以适应更复杂的病例，所以都可以称为完全内镜下手术技术。目前主要用于颈、腰椎间盘突出症、颈椎管狭窄症、腰椎管狭窄症及慢性腰痛等疾病的治疗。     

Techniques and applications of endoscopic spine surgery. Part I: overview of current techniques

Background Spinal pain is a serious health and social-economic problem. Endoscopic spine surgery as a treatment option for spinal pain has gained tremendous attention and growth in the past 2 decades, and a variety of endoscopic techniques have been invented to treat a wide range of spinal conditions. Purposes The purposes of this 2-part review article are to 1 ) overview the published techniques of endoscopic spine surgery, 2 ) summarize the applications of these techniques in treating various spinal conditions, and 3 ) evaluate the clinical evidence of the safety and effectiveness of these endoscopic techniques in treating some of the most common spinal conditions. The first part of the review article provides an overview of currently most commonly used techniques. Methods We searched the PubMed database for publications concerning endoscopic spine surgery and reviewed the relevant articles published in the English language. Results Discectomy and foraminotomy are the most common types of spine surgery that can currently be done endoscopically. Endoscopic techniques have been used to treat a wide range of spinal disorders located in the lumbar, cervical, as well as the thoracic regions of the spine.     

上颈椎融合对颈椎活动度的影响

目的探讨上颈椎融合对颈椎活动功能的影响,并评估颈椎活动度测量仪（cervical range of motion device,CROM）的可靠性。方法我科于2010年7月至2011年10月对收治的14例上颈椎疾病患者使用CROM仪测量,其中5例为颈枕融合,2例寰枢椎融合,7例采用Halo架非融合治疗后2个月及6个月左右颈椎前屈、后伸、左右侧弯、左右旋转主动活动度,并与15例健康志愿者颈椎活动度进行比较,分析术后颈椎活动度丢失情况;使用CROM仪重复测量健康志愿者颈椎活动度并采用组间相关系数（intraclass correlation coefficients,ICC）来评价CROM仪的测量者内可靠性。结果术后6个月随访时颈椎活动度六个方向中的三个方向：颈椎前屈、左旋转及右旋转,融合组与非融合组相比有显著降低（P〈0．05）,与正常组相比则在六个方向均有显著性差异沪〈0．05）。融合组中颈枕融合较寰枢椎融合在颈椎前屈、左右旋转活动上有显著性降低（P〈0．05）,术后第6个月随访各组颈椎活动度较3个月随访时均有一定程度的增加。CROM仪测量颈椎六个方向的活动度测量者内ICC均在0．91以上,有较高的可靠性。结论上颈椎融合使颈椎活动范围显著性减小,对颈椎前屈、旋转功能影响最大。此外,CROM仪是一种可靠的颈椎活动度测量工具。     

第一届全国脊柱外科青年医师暨脊柱脊髓护理学术论坛会议纪要

为进一步促进我国脊柱外科青年医师和护理同道们的学术交流,由中国康复医学会脊柱脊髓损伤专业委员会第一届青年委员会和护理学组主办、中南大学湘雅二医院脊柱外科承办的第一届全国脊柱外科青年医师暨脊柱脊髓护理学术论坛于2014年1月10日至11日在湖南长沙顺利召开。来自国内300余名专家与代表参加了此次学术盛会。在本次会议上,国内众多著名脊柱外科与护理专家、青年技术骨干齐聚一堂,采取主题演讲和专题报告等形式,就脊柱外科和护理领域中的焦点问题展开了热烈研讨。     

Cervical osteochondroma as a cause of spinal cord compression in a patient with hereditary multiple exostoses: Computed tomography and magnetic resonance imaging findings

Spinal cord compression is a rare but extremely serious complication of hereditary multiple exostoses (HME). Imaging of the spine is important for surgical planning and follow up. We present CT and MR findings in a male patient with HME who developed spinal cord compression from a cervical osteochondroma. Complete recovery was achieved following surgery.     

A case of multiple bone metastases from gastric cancer successfully treated with chemo-radiotherapy

A 75-year-old man underwent distal gastrectomy for gastric cancer (CY+, Stage IV) in June 2009. About 4 months after surgery, he had a strong pain in a right shoulder, and became writing difficulty. Some imaging examinations revealed multiple bone metastases, and it was diagnosed that the pain was caused by the tumor of cervical spine. Systemic chemotherapy was started using a regimen of S-1/CDDP, and radiotherapy (30 Gy) was performed for the cervical tumor at the same time. After two-course of the chemotherapy, the shoulder pain disappeared. About 12 months after surgery, he had a strong pain in a left leg, and became walking difficulty. Some imaging examinations revealed a progression of the tumor of lumbar spine. Radiotherapy (30 Gy) was demonstrated for the tumor. After the treatment, the leg pain disappeared. We experienced a case of multiple bone metastases successfully treated with chemo-radiotherapy.     

Widening the horizons of otolaryngologist an interdisciplinary approach for surgical problems of cervical spine

Till recent past the realm of ENT surgeons was limited to tonsils and mastoids. But with the passage of time and strides made by the Biomedical Engineering, the horizon has widened and the Otolaryngology has kept pace with other medical specialities. Lesions of Clivus, cervicomedullary junction and cervical vertebra often present difficulty to the Neuro Surgeon and Orthopaedic Surgeon. The role of ENT surgeon in these cases of cervical spine surgery can be significant. A successful attempt has been made to approach various levels of cervical spine anteriorly either transorally, transpharyngeally or transcervically. Although these techniques are well suited to the training and experience of the Head & Neck ± surgeon, it is our perception that the procedure is underused by the members of our speciality. Although these approaches are safe and reliable, it is not part of the Otolaryngologist’s usual surgical armamentarium. In the present study a series of thirteen patients presented between February ’91 and July ’94, with various pathologies of Cervical Spine with or without neurological deficits is reviewed. The surgical technique is discussed and methods to prevent potential complications and adverse sequelae are also addressed.