脊柱内固定技术学习班通知

目前,我国神经外科领域的脊柱外科手术已逐渐在临床开展,并已纳入发展规划。作为脊柱外科的基础,脊柱生物力学及内固定方面的知识及训练是大家应首先关注的领域。为了给大家提供一个学习交流的平台,中国国际神经科学研究所脊柱外科、     

重视脊髓脊柱外科的发展

笔者在段国升教授等前辈的指导下，于脊髓脊柱外科方面做了些工作，但涉足的领域有限，开展的深度也还不够，要写出较高水准的述评来，颇感为难。国内神经外科界尽管在该领域已取得不少成就，有些疾病（如脊髓内肿瘤等）的手术治疗已达到国际先进水平，但就总体而言，神经外科医师对脊髓脊柱外科还缺乏足够的重视。唤起各位同道更多的关注，切实加强脊髓脊柱疾病的临床诊治及相关基础研究，殊为必要。     

中国神经脊柱外科医师培训的点与面

目的探讨中国神经脊柱外科医师培训的方法与经验。方法通过加强对国内几个重点神经脊柱外科中心建设与发展,在中国神经科学技术有限公司的鼎力支持下,于2013年11月成立了中国神经脊柱学会及讲师团,以点带面,先后在全国范围内举办神经脊柱初级学习班、中级学习班、高级学习班、手术观摩班及临床进修班等,推动了国内神经脊柱外科的快速发展。结果近4年来,中国神经脊柱外科的发展取得了可喜的成就,无论从开展神经脊柱外科的科室数量、手术量、病种数及手术疗效均得到了提高。结论中国神经脊柱外科刚刚起步,各地区间差异较大,与欧美神经脊柱外科及国内骨科脊柱外科的发展差距较大,而中国神经脊柱外科医师培训的以点带面的培训方式效果明显,值得推广。     

微创脊柱内固定技术新进展

随着人口老龄化的加剧,脊柱退行性变发病率逐年上升。近年来,脊柱外科迅速发展,成为神经外科的重要组成部分,脊柱外科不仅专注于病变椎体切除和神经减压,而且重视脊柱稳定性的保护和重建。微创脊柱外科技术是脊柱外科的重要组成部分,包括微创减压技术和微创内固定技术。本文拟对近年来常用的微创脊柱内固定技术进行简要概述。     

脊柱椎弓根螺钉应用的生物力学特征

背景：椎弓根螺钉内固定经过不断的发展和完善,生物力学理论在脊柱内固定器方面也有了很大进展。 目的：对脊柱椎弓根螺钉应用的生物力学研究进行综述。 方法：应用计算机检索1986-01/2010-10 CNKI和Pubmed数据库,在标题和摘要中以“椎弓根螺钉,生物力学”或“Pedicle Screw,Biomechanics”为检索词进行检索。选择文章内容与椎弓根螺钉的生物力学有关者,同一领域文献则选择近期发表或发表在权威杂志文章。最终入选49篇文献进行综述。 结果与结论：在椎弓根螺钉的发展过程中,生物力学不仅为内固定的研制提供理论基础,也是测试和评价新设计内固定器效果的最终依据和标准。文章结果显示椎弓根螺钉植入点、植入方向、螺钉大小、螺钉形状、螺钉材料对脊柱生物力学均有一定影响。     

微创脊柱外科技术的进展

微创手术是外科技术发展的方向,本文对脊柱外科手术中的显微外科技术、内镜技术、经皮穿刺椎体成形及后凸矫形技术等在椎间盘突出、椎管狭窄、椎体骨折及某些脊柱肿瘤手术中的应用及指征进行综述.     

有限元分析在腰椎生物力学研究中的应用

本文介绍了有限元的概念及其原理,总结了有限元分析法在腰椎生理和病理情况下生物力学分析中的应用,概述了不同术式、内固定器械对脊柱生物力学的影响,展望了有限元法在脊柱生物力学研究的应用前景。     

CT扫描结合逆向工程软件建立下胸椎三维有限元模型

背景：脊柱生物力学的研究有赖于三维有限元模型的建立,对于下胸椎的生物力学研究,由于其结构特点,使其对有限元模型的准确性和精确性要求更高。目前脊柱有限元研究通常以颈、腰段为多见,对于下胸段方面的研究,目前文献报道不多。 目的：通过CT扫描结合逆向工程软件建立下胸椎三维有限元模型,为其进一步生物力学研究奠定基础。 方法：选择内蒙古医学院附属医院影像科标本1例,志愿者无脊柱疾患和骨质疏松,对试验方案知情同意。利用非脊柱疾患病例CT资料,利用医学图像处理软件Mimics实现直接从CT图像中提取数据,再利用逆向工程技术平台Geomagic,在可视化的界面下对模型进行修改,建立人完整下胸椎、椎间盘及韧带的有限元模型。 结果及结论：利用Mimics,Geomagic等逆向工程软件,结合CT技术对人下胸椎进行了三维重建,精确再现了下胸椎外形解剖特征,实现了对椎体组织内部不同结构的精细区分,下胸椎共具有112 540个四面体单元。提示此方法可以提高建模的效率和可操作性,能够成功的建立符合实验要求的下胸椎有限元模型。     

导航技术在脊柱神经外科的应用

计算机辅助手术导航系统(CASNS),是经典(框架)立体定向技术、现代影像诊断技术、微创手术技术、电子计算机技术和人工智能技术相结合的产物.1986 年美国的Roberts 等率先将这一技术应用于神经外科临床.至20世纪90 年代Steinmann 等将CASNS 用于脊柱外科,有些学者认为这是脊柱外科发展的一个里程碑.     

椎板切除手术方式与脊柱稳定性关系的研究进展

<正>椎管内肿瘤约占中枢神经系统肿瘤的15%~[1],是神经外科及脊柱外科常见疾病,因大部分为良性肿瘤,手术切除是其主要治疗手段。目前存在多种手术方式,各有其优缺点及相应的适应证,选择恰当的手术方式并保持脊柱生物力学的稳定性是目前椎管内肿瘤治疗的焦点,尽可能完全切除肿瘤并恢复脊柱的稳定性是椎管内肿瘤治疗的基本原则。现就椎管内肿瘤常用椎板切除手术方式的优缺点及其对脊柱     

Automated spinal cord monitoring for spinal surgery

A microcomputer-based automated spinal cord monitoring system was developed and 56 spinal operations have been carried out with it since 1986. The system comprises an electrodiagnostic system (Dantec 2000M), an FM tape recorder, a channel selector, an electrical relay, a Modem and a microcomputer which controls all of the elements. The program allowed for automated recording and analysis of evoked potentials during spinal surgery and alarm signals were generated according to the criteria of amplitude decrease and latency delay. It was demonstrated that automated spinal cord monitoring in the operating room was performed easily, reliably and safely allowing the surgeon to react quickly to possible compromise of the spinal cord. The design and usefulness of the system is described in this report.     

脊髓动静脉畸形、硬脊膜动静脉瘘、硬脊膜外动静脉瘘与脊髓周围动静脉瘘的鉴别

正脊髓血管病比较少见,但是脊髓动静脉畸形(spinal cord arteriovenous marformation,SAVM)、硬脊膜动静脉瘘(spinal dural arteriovenous fistula,SDAVF)、硬脊膜外动静脉瘘(spinal epidural arteriovenous fistula,SEDAVF)、脊髓周围动静脉瘘(spinal perimedullary arteriovenous fistula,SPAVF)四种类型,诊断容易混淆,也容易误诊。这四种脊髓血     

Modulation of spinal neuronal excitability by spinal direct currents and locomotion after spinal cord injury

ObjectiveSpinal neuronal function is impaired after a severe spinal cord injury (SCI) and can be assessed by the analysis of spinal reflex (SR) behavior. We applied transcutaneous spinal direct current stimulation (tsDCS) and locomotor activity, to determine whether the excitability of spinal neuronal circuitries underlying locomotion can be modulated after motor complete SCI.MethodSRs were evoked by non-noxious electrical stimulation of the tibial nerve. SR behavior was assessed before, immediately after, and 20 min after four different interventions (anodal, cathodal, sham tsDCS, or locomotion) in subjects with motor complete SCI and healthy subjects.ResultsSR amplitudes in SCI subjects were increased after anodal tsDCS by 84% (p < 0.05). Cathodal, sham tsDCS and locomotion had no influence on SR amplitudes. In addition, reflex threshold was lower after anodal tsDCS and locomotion in SCI subjects (p < 0.05).ConclusionAnodal tsDCS is able to modulate spinal neuronal circuitries after SCI.SignificanceThis novel, noninvasive approach might be used as a tool to excite spinal neuronal circuitries. If applied repetitively within a training approach, anodal tsDCS might prevent adverse alterations in spinal reflex function in severely affected SCI subjects, i.e., a manifestation of a spinal neuronal dysfunction taking part below the level of a spinal lesion.     

Irreversible damage to the spinal cord following spinal anesthesia

The authors report five patients with damage to the distal spinal cord following spinal anesthesia. The patients developed leg weakness and sensory disturbance. MRI of the lumbosacral spine showed an abnormal area of high signal within the conus medullaris in all patients. Symptoms and signs persisted at 1- to 2.5-year follow-ups. Incorrect needle placement and type of needle used are possible factors leading to spinal cord injury.     

Diagnostic spinal anaesthesia in chronic spinal cord injury pain.

In a double blind study, 21 patients with chronic spinal cord injury (SCI) pain underwent placement of a lumbar subarachnoid catheter and injection of placebo and lidocaine. The effects on pain intensity, distribution, altered sensations and sensory level of anaesthesia were monitored. Four patients responded briefly to placebo, while 13 demonstrated a mean reduction of pain intensity of 37.8 +/- 37% for a mean duration of 123.1 +/- 95.3 minutes in response to lidocaine. The pain response to subarachnoid lidocaine differed significantly (p less than 0.01) from placebo. Spinal anaesthesia was also associated with changes in pain distribution and altered sensation. A spinal anaesthetic-induced sensory level could not be achieved cephalad to the sensory level of neurological injury in 5 patients who presented with spinal canal obstruction. This study has demonstrated that response to diagnostic spinal anaesthesia in chronic SCI pain is complex, requiring individual interpretation in each patient and consideration of the following factors; symptomatology, etiology, pain perception, spinal canal anatomy, CSF chemistry and local anaesthetic pharmacology.