椎弓根螺钉对胸腰段椎管内肿瘤术后脊柱稳定性的作用

目的探讨经后正中入路切除胸腰段椎管内肿瘤,同时行椎弓根螺钉内固定植骨融合后,对提高脊柱稳定性的临床疗效.方法采用后正中入路显微手术切除椎管内肿瘤后,应用椎弓根螺钉内固定植骨融合技术进行椎管重建12例,其中肿瘤位于胸段7例,腰段5例.结果肿瘤全切除10例,近全切除2例.术后出现固定区憋胀疼痛3例,经X-线或CT复查证实共5枚螺钉位置欠佳.随访9个月～5年,X-线检查显示手术区植骨全部骨性融合,脊柱稳定.结论采用后正中入路显微手术切除胸腰段椎管内肿瘤后,应用椎弓根螺钉内固定植骨融合技术,能够维持手术后脊柱的稳定性,防止远期后凸畸形的发生.     

“Ⅵ型田氏脊柱骨刀”征购启事

“Ⅵ型田氏脊柱骨刀”乃由田慧中教授近年来新设计成功的,制造工艺精细优美的一套薄刃骨刀共10把。主要用于腰椎间盘手术的椎板间开窗;半椎板切除全椎管减压术;椎管、根管狭窄扩大术;自后路椎体间植骨或Cage手术的开窗暴露;强直性脊柱后凸的Ⅴ型截骨术;脊柱侧弯的顶椎切除术;小儿先天性半椎体切除术;角形脊柱后凸的全脊柱截骨术;胸腰段爆裂性骨折的前路椎体后缘切除植骨术或Kaneda手术;颈椎前路刨槽植骨术等,均可用这套器械顺利完成手术的全过程,节约了手术时间,避免了用咬骨钳切除椎板时,挤压     

生物陶瓷人工椎体以及脊柱前路解剖型钢板重建椎体的生物力学评价☆

目的：基于胸腰椎解剖学的研究，设计制作了胸腰椎脊柱前路解剖型固定钢板以及生物陶瓷人工椎体，并对应用脊柱前路解剖型固定钢板，Kaneda装置以及生物陶瓷人工椎体等技术重建椎体的动物脊柱标本进行了生物力学测试比较。 方法：实验于2001-10/2002-06在华中科技大学力学系国家重点试验室完成。选取正常成年新鲜牛脊柱标本40具，由华中科技大学力学系试验室提供, 分为正常组，生物陶瓷人工椎体组，脊柱前路解剖型固定钢板加植骨组，Kaneda装置加植骨组，单纯植骨不加任何外固定组。应用与华中科技大学力学系联合研制的生物力学测试系统，采用动态加载，应用传感器动态记录方式，对各组牛脊柱标本进行三维六度的测试分析。 结果：①单纯植骨不加任何外固定组在各个方向均最不稳定。②脊柱前路解剖型固定钢板在前屈，后伸方向明显较Kaneda装置稳定。③在Kaneda装置的对侧即右侧：脊柱前路解剖型固定钢板在右旋，右弯方向与Kaneda装置固定效果相当，甚至稍强。④在Kaneda装置的固定侧即左侧，脊柱解剖型固定钢板的稳定性稍弱于Kaneda装置。⑤生物陶瓷人工椎体的固定效果各个方向均较为理想，明显地高于Kaneda装置固定、脊柱前路解剖型钢板的固定，与正常脊柱相当。 结论：应用生物陶瓷人工椎体以及脊柱前路解剖型钢板重建椎体具有良好的生物力学稳定性。     

后路钉棒系统置入内固定并侧前方减压植骨融合治疗胸腰椎严重爆裂骨折12例

背景：胸腰椎爆裂性骨折侧前方减压植骨融合、钉棒系统内固定术可通过同一切口实现。 目的：观察后路钉棒系统置入内固定并侧前方减压植骨融合治疗胸腰椎严重爆裂骨折合并脊髓及神经根损伤的临床疗效。 方法：回顾采用后路钉棒系统置入内固定,侧前方减压植骨融合治疗12 例胸腰椎爆裂骨折合并神经损伤的病例。 结果与结论：12例患者椎管均获得有效减压,均随访9个月以上。影像学显示植骨块融合良好, 伤椎高度基本恢复,Cobb’s 角由术前平均22°恢复到6°,F rankel 分级恢复1级者6 例,恢复2级者3 例,无变化者3例。结果表明,采用后路钉棒系统内固定加侧前方减压椎体次全切除植骨融合是集减压、复位、内固定、植骨融合、矫正畸形、重建脊柱稳定一次完成的有效方法,但应严格掌握适应证。     

前路显微外科手术治疗多节段颈椎病

目的：探讨单一或多个椎体广泛切除,显微外科手术减压,颈椎植骨融合,钛钢板颈椎固定手术治疗多节段颈椎病的疗效。方法：根据临床表现及神经影像学资料选择24例脊髓型颈椎病患,采用Caspar颈椎手术器械及新型植骨融合固定技术实施手术,于显微镜下切除病变的颈椎椎间盘、椎体和后纵韧带,高速气动磨钻磨除患椎骨赘,以自体髂骨或骨水泥行植骨融合、钛钢板固定。结果：根据Nurick神经功能评价标准,术后92%（22例）的患神经功能不同程度改善,8%（2例）的患症状无改变,无一例症状加重。结论：应用颈椎前入路显微外科手术治疗来自颈脊髓前方压迫的多节段颈椎病患（包括症状严重）,减压彻底,固定稳定,安全可行,多数患疗效满意。     

前路显微外科手术治疗多节段颈椎病

目的探讨单一或多个椎体广泛切除,显微外科手术减压,颈椎植骨融合,钛钢板颈椎固定手术治疗多节段颈椎病的疗效.方法根据临床表现及神经影像学资料选择24例脊髓型颈椎病患者,采用Caspar颈椎手术器械及新型植骨融合固定技术实施手术,于显微镜下切除病变的颈椎椎间盘、椎体和后纵韧带,高速气动磨钻磨除患椎骨赘,以自体髂骨或骨水泥行植骨融合、钛钢板固定.结果根据Nurick神经功能评价标准,术后92%(22例)的患者神经功能不同程度改善,8%(2例)的患者症状无改变,无一例症状加重.结论应用颈椎前入路显微外科手术治疗来自颈脊髓前方压迫的多节段颈椎病患者(包括症状严重者),减压彻底,固定稳定,安全可行,多数患者疗效满意.     

Cage椎弓根内固定联合自体颗粒骨打压植骨的即时生物力学稳定性

背景：自体骨移植结合椎间融合器联合椎弓根螺钉常运用于椎体融合,但单纯颗粒骨打压联合椎弓根钉的临床生物力学研究报道不多。 目的：比较后路自体颗粒骨打压植骨内固定及Cage内固定的即时生物力学稳定性。 方法：利用腰椎后路附件逐级破坏和椎间盘切除制作腰椎不稳模型。12具猪腰椎标本随机分为两组：打压植骨结合椎弓根螺钉内固定组(实验组),Cage结合椎弓根螺钉内固定组(对照组)。使用脊柱三维运动测试机模拟人体对两组标本在正常、不稳、融合3个状态下进行前屈、后伸、左右侧屈、左右旋转等各个活动的生物力学测试,三维激光扫描仪测定不同载荷下不稳节段的运动范围。 结果与结论：正常状态下,两组间L2~3节段各方向运动范围差异无显著性意义(P > 0.05),说明两组标本均衡性好,具有可比性;与正常状态相比,两组不稳状态各方向运动范围亦明显增加(P < 0.05);融合后对照组L2~3节段椎间各方向运动范围均较实验组小,但差异无显著性意义(P > 0.05)。说明自体颗粒骨打压植骨内固定与Cage内固定均能明显提高脊柱的即时生物力学稳定性,而且两组对于改善脊柱稳定性无显著性差异。     

长节段椎板-棘突复合体回植进行椎管重建在长节段椎管内肿瘤手术中的应用

目的 探讨长节段（≥4个节段）椎板-棘突复合体回植进行椎管重建在长节段椎管内肿瘤手术中的应用效果。方法回顾性分析2014年1月至2020年12月显微手术治疗的6例长节段椎管内肿瘤的临床资料。术中采取长节段椎板-棘突复合体回植复位+钛板钛钉固定的方法进行椎管重建。结果 肿瘤位于颈胸段3例，胸腰段1例，腰段1例，腰骶段1例。肿瘤全切除5例，大部分切除1例。术后病理检查显示室管膜瘤3例，神经鞘瘤1例，脂肪瘤1例，畸胎瘤1例。术后随访2～7年，未见肿瘤复发，未见椎管狭窄，未见脊柱不稳及滑脱，部分椎板已骨性愈合。结论 对长节段椎管内肿瘤，采用长节段椎板-棘突复合体回植方法进行椎管重建，手术疗效肯定，术后并发症少，脊柱稳定性影响小。     

下颈椎前路内固定联合后路经关节金属螺钉置入固定的生物力学稳定性

背景：对退变性颈椎管狭窄单纯采用前路椎体次全切除或椎间盘切除或单纯后路单开门椎管扩大成行均不能彻底完成脊髓减压和脊柱三柱稳定。 目的：探讨下颈椎前路固定联合后路经关节螺钉固定的生物力学稳定性。 方法：正常成人尸体颈椎标本,每具分别制作以下两种模型：①经后路C3~C7单开门和下颈椎前路C5椎体次全切除钛网支撑植骨、ORION内固定模型(对照组)。②经后路C3~C7单开门和经关节螺钉内固定及下颈椎前路C5椎体次全切除钛网内植骨、ORION内固定模型(实验组)。 结果与结论：实验组在前屈、后伸、左、右侧屈及左、右旋转移位角度均小于对照组(P < 0.001)。提示：①在生物力学实验中,下颈椎前路固定联合后路经关突节螺钉固定的生物力学性能优良,对抗前屈、后伸、左、右旋转的作用力更强,颈椎可获得更可靠的稳定性。②下颈椎前路固定联合后路经关节螺钉固定在对抗颈椎前屈运动时力学稳定性更为强大。     

颈前路钢板置入内固定加椎间植骨治疗Ⅱ型Hangman骨折的生物力学评价

背景：C2/3椎间盘切除，钢板置入内固定加椎间植骨是治疗Hangman骨折的常用术式。该术式在临床应用广泛，但目前尚缺乏相关实验评价钢板置入内固定治疗Hangman骨折的生物力学特点研究。 目的：评价钢板置入内固定+椎间植骨治疗Ⅱ型Hangman骨折的生物力学稳定性。 方法：6具正常成人新鲜冷冻颈椎，每一标本依次制作成以下3种状态组：即正常对照组、Ⅱ型Hangman骨折模型组、椎间植骨+钢板内固定组。按以上顺序应用脊柱三维运动试验机和三维激光扫描仪测试每一状态C2/3节段的三维运动范围。 结果与结论：与正常对照组比较，Ⅱ型Hangman骨折模型组C2/3节段前屈、后伸、旋转及侧弯关节活动度均显著增大(P < 0.05)，钢板内固定+椎间植骨组旋转方向关节活动度显著增大(P < 0.05)；与Ⅱ型Hangman骨折模型组相比，钢板内固定+椎间植骨组C2/3节段前屈、后伸及侧弯关节活动度均显著减小(P < 0.05)。结果提示钢板置入内固定能够在前屈、后伸及侧弯方向恢复Ⅱ型Hangman骨折的稳定性，然而在旋转方向缺乏稳定作用，术后需辅以外固定以确保融合。     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

The organization of the connections between the cortex and the claustrum in the monkey

The distribution of labelled cells and of extracellular granules in the claustrum has been studied after injections of horseradish peroxidase in several areas of the neocortex. The frontal and parietal lobes are related to the anterior and posterior halves respectively of the claustrum, and the occipital and temporal cortex to the posterior and inferior margins. Parts of the claustrum related to areas of the cortex in the frontal lobe overlap considerably in the antero-posterior dimension with parts related to widely separated but interconnected areas of the parieto-temporal cortex. Areas of cortex within one lobe which are interconnected are related to parts of the claustrum which overlap in the dorsoventral dimension.     

Sexual pheromones and the evolution of the reward system of the brain: the chemosensory function of the amygdala

The amygdala of all tetrapod vertebrates receives direct projections from the main and accessory olfactory bulbs, and the strong similarities in the organization of these projections suggest that they have undergone a very conservative evolution. However, current ideas about the function of the amygdala do not pay sufficient attention to its chemosensory role, but only view it as the core of the emotional brain. In this study, we propose that both roles of the amygdala are intimately linked since the amygdala is actually involved in mediating emotional responses to chemical signals. The amygdala is the only structure in the brain receiving pheromonal information directly from the accessory olfactory bulbs and we have shown in mice that males emit sexual pheromones that are innately attractive for females. In fact, sexual pheromones can be used as unconditioned stimuli to induce a conditioned attraction to previously neutral odorants as well as a conditioned place preference. Therefore, sexual pheromones should be regarded as natural reinforcers. Behavioural and pharmacological studies (reviewed here) have shown that the females' innate preference for sexual pheromones is not affected by lesions of the dopaminergic cells of the ventral tegmental area, and that the systemic administration of dopamine antagonists do not alter neither the attraction nor the reinforcing effects of these pheromones. Anatomical studies have shown that the vomeronasal amygdala gives rise to important projections to the olfactory tubercle and the islands of Calleja, suggesting that these amygdalo-striatal pathways might be involved in the reinforcing value of sexual pheromones.     

A projection to the striatum from the medial subdivision of the posterior group of the thalamus in the cat

Injections of wheat germ agglutinin-conjugated horseradish peroxidase in the lateral part of the caudate nucleus or the putamen of the cat result in retrograde thalamic cell-labeling in the rostral extension of the medial subdivision of the posterior group (POM). Autoradiography after [³H]amino acid injection of POM reveals a dense and discontinuous distribution of axons in the lateral half of the caudate and putamen concentrated at their middle rostrocaudal levels. This newly discovered thalamostriatal projection of POM may account for somatosensory activity observed in striatal cells.     

Role of the paraventricular nucleus in the projection from the nucleus of the solitary tract to the olfactory bulb

Electrophysiological experiments were performed on anesthetized rats to determine the effects of lesions of the paraventricular nucleus on the amplitude of evoked potentials recorded in the periglomerular layer of the olfactory bulb after nucleus of the solitary tract electrical stimulation. Lesions of the paraventricular nucleus enhance the amplitude of both the positive and negative components of the evoked potential in the olfactory bulb. The pathway from the paraventricular nucleus to the olfactory bulb seems to exert a suppressive influence over the projection from the nucleus of the solitary tract to the olfactory bulb under these conditions.     

Evidence for the collateral innervation of the esophagus and the heart from neurons in the compact formation of the nucleus ambiguus of the rat

We investigated whether the heart receives collateral projections from the neurons which innervate the esophagus with a retrograde double-labeling method using two fluorescent tracers. Following injections of True Blue (TB) into the esophagus and Diamidino Yellow (DY) into the heart, about 21.9% of the labeled esophageal motoneurons in the compact formation of the nucleus ambiguus (AmC) were retrogradely double labeled. No single-labeled cardiac motoneurons were found in the AmC. The present results provide anatomical substrates for the esophagocardiac reflex.     

On the origin of the serotonergic input to the intermediate lobe of the rat pituitary

Single stimulations of the vagina and cervix were performed between proestrus and the first day of diestrus with a stimulator designed to grade the intravaginal penetration of a rod. The percent incidence of pseudopregnancy after this stimulation was exponentially related to the extent of intravaginal penetration and was also affected by the stage of the cycle at which the stimulation was performed. At 10.00 h on proestrus, an exponential increase in the incidence of pseudopregnancy was observed with shallow penetrations, while an exponential decrease was found when deeper penetrations were applied. Such negative exponential correlation had disappeared at 22.00 h on proestrus. At that time, also, some responses were elicited by very shallow penetrations (17 mm) and all the animals responded to penetrations of 20 mm or more. Sensitivity to cervicovaginal stimulation at 10.00 h on estrus was lower than that at 22.00 h on proestrus and it was even lower at 10.00 h on the first day of diestrus. The response to 18 mm of penetration was studied every 3 h between 10.00 h on proestrus and 10.00 h on estrus, and then every 12 h until 10.00 h on the first day of diestrus. This stimulation was usually ineffective to induce pseudopregnancy, except for a brief period encompassing the night between proestrus and estrus, when a peak in the incidence of responses was reached. This peak sensitivity could be advanced following the s.c. administration of 250 and 500 ng of LH-RH at 11.00 h on proestrus. Other doses were ineffective. The peptide (500 ng) was unable to induce pseudopregnancy in rats that received no cervicovaginal stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Projections from the five divisions of the orbital cortex to the thalamus in the rat

The orbital cortex (ORB) of the rat consists of five divisions: the medial (MO), ventral (VO), ventrolateral (VLO), lateral (LO), and dorsolateral (DLO) orbital cortices. No previous report has comprehensively examined and compared projections from each division of the ORB to the thalamus. Using the anterograde anatomical tracer, Phaseolus vulgaris leucoagglutinin, we describe the efferent projections from the five divisions of the ORB to the thalamus in the rat. We demonstrated that, with some overlap, each division of the ORB distributed in a distinct (and unique) manner to nuclei of the thalamus. Overall, ORB projected to a relatively restricted number of sites in the thalamus, and strikingly distributed entirely to structures of the medial/midline thalamus, while completely avoiding lateral regions or principal nuclei of the thalamus. The main termination sites in the thalamus were the paratenial nucleus (PT) and nucleus reuniens (RE) of the midline thalamus, the medial (MDm) and central (MDc) divisions of the mediodorsal nucleus, the intermediodorsal nucleus, the central lateral, paracentral, and central medial nuclei of the rostral intralaminar complex and the submedial nucleus (SM). With some exceptions, medial divisions of the ORB (MO, VO) mainly targeted “limbic-associated” nuclei such as PT, RE, and MDm, whereas lateral division (VLO, LO, DLO) primarily distributed to “sensorimotor-associated” nuclei including MDc, SM, and the rostral intralaminar complex. As discussed herein, the medial/midline thalamus may represent an important link (or bridge) between the orbital cortex and the hippocampus and between the ORB and medial prefrontal cortex. In summary, the present results demonstrate that each division of the orbital cortex projects in a distinct manner to nuclei of the thalamus which suggests unique functions for each division of the orbital cortex.