ANTERIOR SPINAL FUSION WITH TSRH INSTRUMENTATION FOR SCOLIOSIS

Objective. To introduce a new spinal internal fixation system, Texas Scottish Rite Hospital (TSRH), and to investigate its early clinical outcomes.Methods. The preliminary clinical outcomes of 15 patients with thoracolumbar or lumbar scoliosis treated by anterior spinal fusion with TSRH instrumentation were studied retrospectively. Fourteen patients were diagnosed as idiopathic scoliosis and 1 as neuromuscular scoliosis.Results. Preoperatively, the Cobb's angle on the coronal plane was 55. 8° (range 35° - 78°), and 14° postoperatively, with an average correction of 74. 8 %. The average unfused thoracical curve was 35. 9 ° preoperatively (range 26° - 51°) and 21. 8° (10°-42° ) postoperatively, with 40% correction. The sagittal curve of lumbar was kept physiologically, preoperative 27. 9° and postoperative 25. 7° respectively. The trunk shift was 13.4 mm (5 - 28mm) preoperatively and 3. 5 mm (0-7 mm) postoperatively. The averaged apic vertebra derivation was 47. 8 mm (21 - 69 mm) before operat     

胸椎管狭窄合并脊髓压迫症

探讨了18例胸椎管狭窄合并脊髓和神经根压迫症的治疗方法和效果。该18例多属晚期病例,出现了完全或不全瘫痪。经X线检查、脊髓造影和CT扫描确诊,17例行椎管减压,切除椎板4～11个,7例完全恢复,7例截痪明显改善,3例无效。本文还讨论了如何早期诊断和提高疗效。     

脊髓血管畸形的显微外科手术

本文报道了30例脊髓血管畸形,占同期脊髓疾病手术的12.66％;男23例、女7例,成年组占73.3％。其主要临床症状和体征是瘫痪和感觉障碍。Queckenstedt试验是重要检查方法。脑脊液的蛋白含量0.85～15.76g/L(平均2.63 g/L)。23例(76.6％)位于胸段,1例手术的病人波及14个节段(颈_7～腰_2)。病理分型为动静脉畸形,毛细血管瘤和海绵状血管瘤。本病最佳治疗方法是在手术显微镜下的全切除。经过3个月至9年的随访46.7％恢复原来的工作,33.3％能生活自理,只有20％无效。     

脊髓压迫症(附54例分析)

本文分析54例脊髓压迫症的病因,临床特征,检查方法及治疗结果。指出此病的主要临床表现有感觉减退,进行性肌肉无力,肌肉萎缩和局限性肌纤维震颤,腱反射可为减弱或亢进,病理性反射阳性及括约肌功能障碍等,讨论常被误诊为肌萎缩侧索硬化症的原因。着重指出临床医务人员应重视神经系统体征的检查,     

低温保存对大鼠胚胎脊髓细胞的影响

本实验目的是研究低温存保对大鼠胚胎脊髓细胞的影响。选用胎龄１４天的Ｗｉｓｔａｒ大鼠，分离胚胎脊髓，剪成１ｍｍ＾３的小块。放入冻存液，逐渐降温，最后置于液氮中保存。１５天后取出，快速复温，冲洗，并植入正常大鼠脊髓内，同时对死亡和存活细胞计数和涂片，经计算机图像处理，算出细胞存活率和核质比例。实验结果显示：经低温保存的胚胎脊髓细胞存活率低于未经低温保存组；两组的存活细胞形态和核质比无明显改变。经过低温     

神经降压素在大鼠脊髓的分布

应用免疫组化ＰＡＰ法观察了神经降压素在大鼠脊髓的分布，结果显示：在脊髓横断面上，神经降压素反应阳性纤维成双带分布于脊髓后角，主要位于Ⅱ、Ⅲ板层，以胸段最密集；神经降压素反应阳性神经元位于Ⅲ板层外侧，为园形或多角形，与其它神经元形成接触。结果提示，神经降压素在感觉传导通路中起重要的作用。     

SURGICAL TREATMENT OF SCOLIOSIS CAUSED BY NEUROFIBROMATOSIS TYPE 1

Objective To retrospectively analyze the relationship between curve types and clinical results in surgical treatment of scoliosis in patients with neurofibromatosis type 1 (NF-1).Methods Forty-five patients with scoliosis resulting from NF-1 were treated surgically from 1984 to 2002. Mean age at operation was 14.2 years. There were 6 nondystrophic curves and 39 dystrophic curves depended on their radiographic features. According to their apical vertebrae location, the dystrophic curves were divided into three subgroups: thoracic curve (apical vertebra at T8 or above), thoracolumbar curve (apical vertebra below T8 and above L1), and lumber curve (apical vertebra at L1 and below). Posterior spine fusion, combined anterior and posterior spine fusion were administrated based on the type and location of the curves. Mean follow-up was 6.8 years. Clinical and radiological manifestations were investigated and results were assessed.Results Three patients with muscle weakness of low extremities recovered entirely. Two patients with dystrophic lumbar curve maintained their low back pain the same as preoperatively. The mean coronal and sagittal Cobb′s angle in nondystrophic curves was 80.3° and 61.7° before operation, 30.7° and 36.9° after operation, and 32.9° and 42.1° at follow-up,respectively. In dystrophic thoracic curves, preoperative Cobb's angle in coronal and sagittal plane was 96.5° and 79.8°,postoperative 49.3°and 41.7°, follow-up 54.1° and 45.3°, respectively. In thoracolumbar curves, preoperative Cobb's angle in coronal and sagittal plane was 75.0° and 47.5°, postoperative 31.2° and 22.8°, follow-up 37.5° and 27.8°, respectively. In lumbar curves preoperative Cobb's angle in coronal plane was 55.3°, postoperative 19.3°, and follow-up 32.1 °. Six patients with dystrophic curves had his or her curve deteriorated more than 10 degrees at follow-up. Three of them were in the thoracic subgroup and their kyphosis was larger than 95 degrees, and three in lumbar subgroup. Hardware failure occurred in 3cases. Six patients had 7 revision procedures totally.Conclusions Posterior spinal fusion is effective for most dystrophic thoracic curves in patients whose kyphosis is less than 95 degrees. Combined anterior and posterior spinal fusion is stronger recommended for patients whose kyphosis is larger than 95 degrees and those whose apical vertebra is located below T8. Patients should be informed that repeated spine fusion might be necessary even after combined anterior and posterior spine fusion.     

银杏叶提取物对实验性脊髓损伤后细胞凋亡的影响

目的观察银杏叶提取物(GBE)对脊髓损伤后神经细胞凋亡的影响。方法选择SD雄性大鼠(SPF级)30只,随机分成对照组和GBE组,均采用改良的Allen打击法制成中度急性脊髓损伤模型,术后GBE组给予GBE 0.75 mL/(kg.d),对照组给予等量生理盐水。分别于术后1、3、5、71、4 d处死动物取材,采用流式细胞仪检测伤段脊髓细胞凋亡的情况。结果对照组和GBE组均发现凋亡细胞,均在5 d达到高峰,但GBE组凋亡细胞比率显著低于对照组(t=4.97~9.56,P<0.05)。结论GBE能够减少神经细胞的凋亡;抗凋亡可能是GBE缓解急性脊髓损伤的诸多机制之一。     

大鼠实验性急性脊髓损伤时NF-κB表达的研究

目的探讨大鼠实验性急性脊髓损伤时NF κB表达的变化。方法应用免疫组织化学、电泳迁移率变化分析 (electrophoreticmobilityshiftassays,EMSA)、Westernblotanalysis(WBA)等方法 ,对脊髓胞核与胞浆内NF κB在各个时点表达的变化进行了系统观察。结果急性脊髓创伤性损伤中可使脊髓胞浆和胞核内NF κB的表达明显升高。结论NF κB被激活是急性脊髓损伤继发性损伤的重要分子机制。     

低温预处理对大鼠脊髓损伤早期病理形态学的影响

目的观察低温预处理对大鼠脊髓损伤早期病理形态学的影响。方法采用改良Allen氏打击法建立大鼠脊髓损伤模型,损伤前应用局部脊髓低温灌注给予低温预处理,采用HE染色观察脊髓损伤早期病理形态学改变,Hplas-100病理图文分析系统对脊髓损伤中心区残留白质面积进行定量分析。结果实验组脊髓损伤早期病理形态学改变较对照组轻,损伤中心区残留白质面积大于对照组,差异有统计学意义（P〈0.01）。结论低温预处理对大鼠正常脊髓形态结构无明显影响,可明显减轻大鼠脊髓损伤早期病理形态学损害,减少损伤中心区白质面积的丢失。     

MSCs移植并GS对大鼠脊髓损伤后期修复的影响

目的观察骨髓间充质干细胞(MSCs)移植联合应用促细胞生长物质(GS)对脊髓损伤后期大鼠运动功能修复的影响。方法应用全骨髓法分离培养MSCs,10 mg/L的BrdU标记细胞核。将成年雄性Wistar大鼠36只,以改良Allen打击法制备T10脊髓损伤模型,制模后2周随机分为MSCs+GS组、MSCs组与对照组,每组12只,伤后2周各组损伤处分别注入MSCs+GS、单纯MSCs、培养液。分别于伤后1、2、3、4、5、6周进行BBB评分;损伤后6周处死大鼠,取损伤段脊髓及其上下各1 cm组织,行苏木精-伊红染色及SABC免疫组织化学方法染色,观察损伤脊髓组织病理变化和BrdU阳性细胞及GAP-43的相对表达。结果制模后1~2周3组大鼠后肢运动功能BBB评分未见明显差异(F=0.322、0.044,P>0.05),3~6周MSCs+GS组大鼠后肢运动功能BBB评分较MSCs组和对照组高(F=13.729~97.187,P<0.05);MSCs+GS组大鼠脊髓损伤中心及头、尾端均可见BrdU染色阳性细胞。同时,MSCs+GS组及MSCs组损伤节段脊髓内GAP-43的表达面积明显多于对照组,MSCs+GS组多于MSCs组。结论 MSCs移植联合GS促进大鼠损伤脊髓结构和功能恢复的效果明显优于单纯细胞移植,两者联用具有协同效应。     

胚胎脊髓移植修复周围神经缺损的超微结构研究

目的：探讨胚胎脊髓移植修复周围神经缺损的超微结构,方法：取家兔4只,手术造成双侧坐同神经缺损,左侧选用胎兔脊髓桥接,右侧为自体神经桥接。分别于术后1,2,3个月取移植段组织标本在透射电子显微镜下观察,结果：3组的胚胎脊髓移植段均可见大量的正常神经纤维,其轴突直径,髓鞘厚度与对照侧无显著性差异（P＞0．05）。结论：胚胎脊髓移植修复周围神经缺损是可行的。     

利伐沙班对脊髓损伤术后静脉血栓栓塞性疾病的影响

目的 探讨和研究利伐沙班对于脊髓损伤术后静脉血栓栓塞性疾病的影响和安全性.方法 前瞻性分析和比较2010-2013年于该院明确诊断为颈或胸脊髓损伤并行手术治疗的患者83例,其中40例于术后给予口服利伐沙班(观察组),43例未给予抗血栓药物(对照组).结合随访资料,评价并比较二组患者在术后关于静脉血栓栓塞性疾病的各临床指标以及利伐沙班的安全性指标.结果 利伐沙班组与对照组相比并未显著增加术后引流量、出血风险和不良风险(P＞0.05),但利伐沙班组的深静脉血栓发病率和肺栓塞的发病率均显著低于对照组(P＜0.05).结论 利伐沙班可以有效降低脊髓损伤术后患者静脉血栓栓塞性疾病的发病率,并不增加术后出血等不良风险,在临床工作中可以进一步使用.     

脊髓全横断后腹角神经元NT-3的表达

目的研究大鼠脊髓全横断后,NT-3在损伤部位相邻节段脊髓腹角神经元随时间的表达变化,为进一步探索脊髓损伤后的再生修复机制和神经营养因子治疗脊髓损伤提供实验依据。方法体重为250g左右成年SD大鼠48只,随机分为六组。分正常组、假手术组及胸10脊髓节段全横断术后1,3,7,14d组。动物到达存活时间后,应用免疫组织化学SABC法和图像分析技术检测NT-3在脊髓损伤相邻节段腹角的表达和分布。结果正常组的NT-3免疫反应阳性细胞主要分布在腹角的大神经元和少量小神经元。损伤区上段的NT-3免疫反应阳性细胞数,在脊髓腹角的表达,均于术后1d组开始明显增高并达到高峰,术后3d、7d组逐渐回落,术后14d组接近正常水平。而损伤区下段的NT-3免疫反应阳性细胞数,在脊髓腹角的表达均于术后1d组开始明显增高,术后3d组达到高峰,于7d组开始下降,到14d组接近正常水平。结论在脊髓全横断术后,脊髓腹角神经元对NT-3的需求增加,提示NT-3在脊髓修复中起重要作用。     

细胞移植修复脊髓损伤的研究进展

脊髓损伤的修复,一直是医学界的难题.大量的动物实验证实,细胞移植能促进脊髓损伤的修复,为治疗脊髓损伤带来了新的希望.本文就细胞移植治疗脊髓损伤的有关研究进展进行综述.     

小熊猫颈髓灰质细胞构筑的研究

以冰冻切片,尼氏染色,参照Rexed氏对猫脊髓细胞分布与灰质分层的原则,对我国珍稀动物—小熊猫的颈髓灰质作了详细观察。结果发现小熊猫的颈髓细胞分布与分层基本上与猫类似,但各层的范围与细胞分布有一定的差异。     

小熊猫胸髓灰质细胞构筑的研究

对成年的小熊猫胸髓的Nissl染色和Luxol fast blue染色切片进行了观察研究,结果表明小熊猫胸髓灰质的分层情况与猫类似,但各层范围与结构存在一定差异。