免疫反应在实验性游离型腰椎间盘突出自然吸收中的意义

目的：通过检测CD3和IgG在实验性游离型腰椎间盘突出自然吸收中的表达，探讨腰椎间盘突出后能否自然吸收及其可能的吸收机制。方法：将25只成年狗平均分成5组，从L2/3切取髓核组织，置于L5处的硬脊膜外，于术后2，4，6，8，12周，取动物标本以及正常部位的髓核组织，用CD3抗体和抗IgG进行免疫组化检测。结果：约30%的标本局部为脂肪组织，54%的标本局部硬脊膜与骨粘连，16%的标本既无粘连也无脂肪，免疫组化测定显示，随着时间的推移，CD3^ 细胞的浸润程度呈递减趋势，而IgG沉积的分布程度呈递增趋势，正常髓核无CD3^ 细胞浸润，IgG沉积分布极少。结论：在椎管内，狗游离的髓核组织8-12周后可部分或全部自然吸收，其吸收机制是机体自身免疫反应的结果。     

腰椎椎弓崩裂CT征象的临床诊断价值

目的分析腰椎椎弓峡部裂的CT表现,探讨各个征象的诊断价值和意义.方法自可疑椎弓峡部裂脊椎的椎弓根的上缘至下一个椎弓根上缘,层厚2～3mm连续扫描.结果86例中发生L5椎弓峡部裂51例,L4者33例,L3,者2例.各种CT征象发现率为:环裂征91%,椎体前移征85%,双椎体征50%,椎管拉长征45%,双关节面征38%,葫芦征26%,游移征15%,磨旋征6%.结论环裂征是该病的特征性表现;双关节面征及葫芦征发现率较低,但特异性较高.椎管拉长征具有一定诊断价值,其它征象无论其发现率大小,均是该病的继发改变,不能作为确诊的直接依据.     

对AF系统整复压缩爆裂骨折椎体高度及椎管横截面的观测

目的 :量化评价AF系统恢复胸腰段压缩爆裂椎体高度椎管截面积的效果。方法 :测量AF系统治疗的 72例胸腰段压缩爆裂骨折术前后影像。统计椎体前后缘高度、Cobb角、椎管截面积资料。结果 :术后伤椎前缘高度恢复至 ( 96.5± 2 .3 ) %后缘高度恢复至 ( 98.2± 0 .9) % ,Cobb角恢复至 ( 5 .4± 1.5 )° ,椎管截面积恢复至 ( 97.2± 2 .1% ) ,各项指标与术前比较有非常显著性差异 (P <0 .0 0 1)。术后随访 0 .5～ 3 .5年 ,神经功能按Frankel评定 :60例提高 1～ 3级。结论 :AF系统能恢复或基本恢复胸腰段压缩爆裂骨折椎体的前后缘高度、Cobb角、椎管容积 ,为脊髓神经功能的恢复提供一个良好的环境。是治疗脊柱胸腰段压缩爆裂骨折较好的内固定器。     

腰椎管狭窄症的手术减压与内固定选择(259例临床分析)

目的：探讨腰椎管狭窄症的手术减压指征、减压范围及内固定选择。方法：回顾性分析腰椎管狭窄症患者259例，平均年龄52．2岁，平均病程4年1个月。根据病情分别采用椎板间节段开窗潜行减压术139例，腰椎管内径扩大成形术63例，全椎板切除减压、椎间植骨融合内固定术57例。结果：221例获得平均4年2个月随访。三种手术方法优良率分别为91．53％、87．50％和85．45％；手术并发症发生率为13．69％、15．87％和20．11％。结论：对严重的腰椎管狭窄症若手术适应证和减压范围掌握恰当，不论采取何种手术方式的神经减压术，均可取得满意疗效。正确选择病例和熟练的外科技术是应用内固定器械的重要条件。     

螺旋CT对正常成人下腰椎侧隐窝的研究

目的:研究正常人下腰椎侧隐窝的形态和测量方法,探讨对侧隐窝狭窄的诊断?方法:采用尸体标本解剖与螺旋CT多层面容积重建和表面遮掩显示相结合方法对侧隐窝进行观察,选择椎体上1/4横断面作为研究平面,测量120例下腰椎双侧侧隐窝矢状径?椎管正中矢状径,计算椎管正中矢状径与双侧侧隐窝矢状径的比值,分析其相互关系?结果:下腰椎侧隐窝分三型:三角型?三叶草型和牛角型;正常成人双侧侧隐窝矢状径不对称,右侧略大于左侧(P<0.05),椎管正中矢状径与双侧侧隐窝矢状径的比率相对恒定(P>0.05),正中/右侧=3.93,正中/左侧=4.03?结论:椎体上1/4横断面为侧隐窝入口平面,利用矢状径比值的方法来判断侧隐窝狭窄具有科学性?     

Prosthetic joint infectionsin the elderly

Total joint arthroplasty is among the most remarkable advances in orthopaedic surgery for the elderly, enabling themto regain physical function and be free of pain. Although uncommon, infection of the prosthetic joint causes serious morbidity leading to poor functional outcome with a mortality approaching 8% in the elderly. Most infections occur through inoculation of the prosthesis at the time of implantation and are due to Gram-positive cocci, although a third of the episodes are due to Gram-negative bacilli from a secondary focus. The management presents a major clinical and therapeutic challenge due to systemic and local comorbid conditions in the elderly. Medical and surgical treatment decisions for infected joint prosthesis are complex and should be individualized in each case. Optimal nutrition is essential for a successful outcome. Adverse reactions to medications are more common in the elderly due to end organ dysfunction and drug-drug interactions.     

Percutaneous radiofrequency rhizotomy of lumbar spinal facets: The results of 46 cases

The results of percutaneous radiofrequency rhizotomy of lumbar spinal facets in 46 patients followed at least three months (mean 15 months) are reported and compared with those reported previously. Satisfactory pain relief three months after the procedure was achieved in 36.4 percent of patients without operations and in 41.7 percent of patients with operations other than fusion.No patient had previously undergone fusion.Treatment of low-back pain by using radio-frequency thermocoagulation of spinal facets is a simple, safe, and well-tolerated procedure. It can be used to relief of pain in spite of decreasing rates of success within the follow-up period.     

Effect of compressive follower preload on the flexion-extension response of the human lumbar spine.

Traditional experimental methods are unable to study the kinematics of whole lumbar spine specimens under physiologic compressive preloads because the spine without active musculature buckles under just 120 N of vertical load. However, the lumbar spine can support a compressive load of physiologic magnitude (up to 1200 N) without collapsing if the load is applied along a follower load path. This study tested the hypothesis that the load-displacement response of the lumbar spine in flexion-extension is affected by the magnitude of the follower preload and the follower preload path. Twenty-one fresh human cadaveric lumbar spines were tested in flexion-extension under increasing compressive follower preload applied along two distinctly different optimized preload paths. The first (neutral) preload path was considered optimum if the specimen underwent the least angular change in its lordosis when the full range of preload (0-1200 N) was applied in its neutral posture. The second (flexed) preload path was optimized for an intermediate specimen posture between neutral and full flexion. A twofold increase in flexion stiffness occurred around the neutral posture as the preload was increased from 0 to 1200 N. The preload magnitude (400 N and larger) significantly affected the range of motion (ROM), with a 25% decrease at 1200 N preload applied along the neutral path. When the preload was applied along a path optimized for an intermediate forward-flexed posture, only a 15% decrease in ROM occurred at 1200 N. The results demonstrate that whole lumbar spine specimens can be subjected to compressive follower preloads of in vivo magnitudes while allowing physiologic mobility under flexion-extension moments. The optimized follower preload provides a method to simulate the resultant vector of the muscles that allow the spine to support physiologic compressive loads induced during flexion-extension activities.     

撑开式椎板成形术治疗伴有马尾神经损害的腰椎间盘突出症

目的总结分析伴有马尾神经损害的腰椎间盘突出症的临床特点,并对手术方法进行探讨.方法对采用撑开式椎板成形术治疗的26例伴有马尾神经损害的腰椎间盘突出症患者的临床资料进行回顾性分析.结果获得随访资料26例平均随访6年5个月,根据Macnab疗效标准,优17例,良7例,可1例,差1例.优良率92.3%.结论伴有马尾神经损害的腰椎间盘突出症的临床症状重,手术治疗需要彻底减压方能取得优良效果.采用撑开式椎板成形术显露,除具有全椎板切除的优点,还不破坏腰椎后柱的稳定性,最大限度地保留了脊柱的完整性,减小了手术创伤,是行之有效的手术方法.     

体重对腰椎后路开窗减压手术疗效的影响

目的对不同体重老年腰椎管狭窄患者行单纯腰椎后路开窗减压手术,并评价其治疗效果。方法回顾性分析1996年12月～2002年12月间145例因老年腰椎管狭窄而采用单纯腰椎后路开窗减压手术治疗患者的病例资料,结合问卷调查患者对手术的满意程度,比较不同体重患者住院期间及术后症状改善情况,评估手术疗效。结果不同体重患者术后腰腿疼痛明显缓解、日常生活质量改善,患者对手术的满意率达67.59%。而且患者的各种统计数据表明,不同体重组之间差异无显著性意义(P>0.05)。结论体重在一定程度上影响老年腰椎管狭窄患者的手术治疗结果。单纯腰椎后路开窗减压手术,可以达到较为理想的治疗效果。