腰椎退行性疾病中的黄韧带超微结构的改变

目的：通过对5例腰椎骨折患者及6例腰椎退行性疾病患者黄韧带组织超微结构的研究，探讨其组织结构方面的变化特征及其与腰椎退行性疾病间的关系，讨论其在腰椎退行性疾病中的病因学意义。方法：应用光镜及透射电镜和扫描叱镜观察上述标本超微结构的变化。结果：黄韧带组织显示细胞数量明显增多，弹力纤维成分减少，胶原纤维成分增多。中央部分组织表现出有合成活性的成纤维细胞及软骨化生的形态学特征。侧隐窝部黄韧带表现出纤维软骨的特征。结论：腰椎退变性疾病患者的黄韧带组织有不同程度的纤维化，软骨化生及纤维软骨化的退变特征。这些改变降低了其弹性。这些超微结构的变化与腰椎退行性疾病的病理过程有密切的关系。     

黄韧带致压颈脊髓的生物力学实验研究

目的观察不同姿势下黄韧带致压颈脊髓时,不同压缩比和不同压缩面积与硬膜囊前后方压力变化的关系。方法C4-C5间钻圆形骨孔,设计一致压棒穿过该骨孔来模拟黄韧带突出物的致压作用。最大压缩比为椎管前后径的60%。同时用压力传感器通过前方开孔记录前方压力变化,改变颈椎姿势后重复实验。结果当压缩比较小时(10%～20%),压缩力在左弯(30°)时最大,当压缩比较大时(50%～60%),压缩力在前屈(30°)时最大。前方测得的压力大约是后方压力的27.8%,且随着压缩头直径的增大而增大。结论硬膜囊上所受的压力同压缩比、压缩头直径以及颈椎姿势关系密切。已受压的颈脊髓在全前屈及全后伸运动中更容易受到伤害。     

Patent ductus arteriosus, large right pulmonary artery and brachiocephalic trunk variations. A case report

Aortic arch anomalies occur due to disorders of the development of primitive double aortic arch system. In this study a patent ductus arteriosus, which had the appearance of a muscular type artery, was observed in addition to an enlarged right pulmonary artery with a diameter of 2.4 cm, causing thickening to right ventricular wall. A left common carotid artery arising from the brachiocephalic trunk was also observed. Such a complicated variation is extremely rare.     

胸椎黄韧带骨化症合并硬脊膜骨化的诊断与手术治疗

目的研究胸椎黄韧带骨化症(OTLF)合并硬脊膜骨化(OD)更有效的诊治方法。方法对1988～2003年经治的8例OTLF合并OD患者的临床表现、影像学特征、手术方法及结果进行回顾性分析。结果全部患者术后病理检查,证实均符合OTLF合并OD。术后均获随访,随访期6～52个月,平均32个月,根据Otani’s分级法和下肢感觉运动功能恢复情况综合评定,优良率62.5%,有效率87.5%。结论MRI结合CT或CTM检查是诊断OTLF合并OD的有力依据。后路全椎板切除减压是治疗OTLF合并OD可取的术式。     

利用根黄通道减压治疗胸椎黄韧带骨化合并脊髓病

目的描述骨化黄韧带的形态及根黄通道的结构,探讨利用根黄通道后壁减压治疗黄韧带骨化合并胸椎脊髓病的可行性。方法2002年1月至2006年1月手术治疗胸椎黄韧带骨化合并脊髓病74例,男45例,女29例;年龄31~73岁,平均51.9岁。所有患者以CT仿真内窥镜及三维同步定位像观察椎管内骨化黄韧带的形态,确定根黄通道的结构、测量根黄通道的最小横径。采用层揭薄化法,将减压器械伸入到根黄通道内游离、孤立骨化组织进行减压。用JOA括约肌功能评分和下肢运动功能评分以及运动功能恢复率评估疗效。结果CT三维重建下,骨化黄韧带呈"独轮车"样结构。"车体"的终止部和"车柄"分别形成上、下根黄通道的上壁;根黄通道的两侧壁分别为骨化黄韧带和椎弓根;外口为椎间孔,内口与椎管相通。下根黄通道最狭窄处宽度为(1.9±0.93)mm。术中见根黄通道的下壁被硬膜封闭,通道内无硬膜填充。全部病例随访时间3~24个月,平均12.5个月。感觉障碍及下肢麻木疼痛完全恢复56例,部分恢复15例。术后括约肌功能JOA评分为(2.599±0.493)分,与术前比较差异有统计学意义(t=17.19,P<0.01);术后运动JOA评分为(3.716±0.702)分,与术前比较差异有统计学意义(t=21.84,P<0.01),恢复率平均为89.7%。疗效优良率为95.9%。结论上、下根黄通道上壁是骨化黄韧带组织与生理骨性结构间的连接点。根黄通道内空虚,器械进入根黄通道切断其上壁,孤立、游离骨化组织是相对安全、便捷的减压方法。     

黄韧带退行病变的发病机制的研究进展

黄韧带是脊柱后部的重要连接结构,主要由弹力纤维、胶原纤维、网状纤维和基质4种成分构成,其中弹力纤维和胶原纤维分别占80%和20%。十几年来,由于对黄韧带形态学、生物力学及其组织化学的深入研究,对其病理状态及其发病的分子机制有了较深的认识。     

项韧带钙化与颈椎病黄韧带退变的相关性研究

[目的]探讨不同节段项韧带钙化与脊髓型颈椎病黄韧带退变的相关性。[方法]取脊髓型颈椎病患者黄韧带192块（项韧带钙化28个节段，相应黄韧带标本56块）和青壮年颈椎创伤（非颈椎病）的黄韧带标本38块。对切除的黄韧带标本进行测量及组织学检查；用Woessner法测定其胶原含量；用盐析法对黄韧带中的Ⅰ型／Ⅱ型胶原含量比进行测定；对黄韧带厚度与羟脯氨酸、胶原干粉含量及Ⅰ型／Ⅱ型胶原含量比进行相关性研究。[结论]颈椎病组中项韧带钙化相应节段的黄韧带弹力纤维含量下降，胶原纤维含量增加，弹力纤维发生排列紊乱。实验组中C4，5、C5，6项韧带钙化相应的节段黄韧带厚度、羟脯氨酸含量、Ⅰ型／Ⅱ型胶原含量比较阴性对照组有显著差异（P〈0．05）；而C3，4、C6，7项韧带钙化相应节段的黄韧带上述指标则无显著差异（P〉0．05）。[结论]C4，5、C5，6节段的项韧带钙化与颈椎病黄韧带的退变有相关性；上述节段的项韧带钙化提示存在应力异常分布，可能会加剧黄韧带退变，进而影响脊髓型颈椎病的发病进程。     

Cervical cyst of the ligamentum flavum and C7-T1 subluxation: case report

A patient with progressive gait disturbance resulting from a cyst of the cervical ligamentum flavum associated with C7-T1 listhesis is reported. Surgical removal of the cyst improved the patients myelopathy. Intraspinal degenerative cysts are preferentially located in the lumbar region:unusual is the cervical localization. Differential diagnosis includes ligamentum flavum cyst, synovial and ganglion cysts. Association between degenerative intraspinal cysts and listhesis is discussed. To our knowledge, this is the first case of cyst of the ligamentum flavum associated with cervical subluxation.     

Ligamentum paracolicum dextrum--a new ligament?

Purpose

During routine laparoscopy, the authors identified an unknown ligament that stretched between the middle segment of the ascending colon and the adjacent lateral abdominal wall. This report discusses the incidence and histology and suggested name for this ligament.

Methods

Over a 5-year period, 362 hernias were repaired laparoscopically in children aged from 4 days to 14 years (median 1.7 years; 87 girls and 242 boys). None of the children had undergone previous surgery nor had had concomitant diseases or associated malformations. The ligament was searched for in every child. In addition, 22 adult cadavers were dissected searching for the ligament. Biopsies were taken from the ligament and from adjacent abdominal wall in other cadavers as controls.

Results

During laparoscopy, a ligament of variable size was identified in 152 of the children (43%). This ligament arose at the lateral aspect of the middle ascending colon, occupied half of the circumference, and inserted at the lateral abdominal wall; there was no recognizable relation to any defined structure at the abdominal wall itself. Similar ligaments were also identified during the cadaveric dissections in 14 (64%) of 22 adult cadavers, in which the variable thickness and broadness were also noted. Histological examination of samples taken from the cadavers showed a loosely structured subepithelial layer of connective tissue of variable width, which transitioned gradually into the subperitoneal fat tissue.

Conclusions

This ligament easily evades the attention of surgeons in open surgery, yet becomes evident during laparoscopy. In the semilateral or lateral position, most frequently chosen for transabdominal laparoscopic access to the kidney, the ligament stretches and keeps the colon on top of the kidney. The ligament's clinical and anatomic significance is unknown. Its existence has become more evident with recent use of laparoscopy.     

胸椎黄韧带骨化症的诊断与手术治疗

目的：回顾性地研究了32例胸椎黄韧带骨化症（OTLF）的临床表现,诊断及手术治疗效果。方法：对1990年～1999年收治的32例OTLF病人的临床表现、影像学特征和手术方法及结果进行描述。其中黄韧带骨化95处,合并胸椎间盘突出（TDH）8例,后纵韧带骨化（OPLL）6例。32例病人均经手术治疗。结果 ：32例均经病理证实为OTLF。30例随访5～72月。根据下肢感觉和运动功能恢复情况进行评价：优11例;良10例;可7例;差2例,优良率73.3%,有效率93.3%。无严重并发症发生。结论：OTLF临床表现无特征性：MRI结合CT检查是诊断OTLF的最佳影像学手段;手术减压是唯一有效的治疗方法。