Lumbar Root Stimulation for Restoring Leg Function: Results in Paraplegia

Abstract: We have implanted an intradural array of 12 tripolar electrodes on the anterior roots L2-S2, left and right, at cauda equina level, in a 33-year-old woman with a complete T9 cord lesion of 3 years' duration. They are driven by an implanted multiplexed stimulator system using radio frequency (RF) power and control signals. All channels generate movements, in patterns that might be predicted from the known anatomy of the cauda equina. In particular, stimulation of L2 and L3 gives hip adduction; L3, L4, and L5 gives quadriceps femoris movements; L5, S1, and S2 gives hamstrings movement; and S1 and S2 give plantar flexion. Stimulation of L5 gives mixed movements at the ankle. Surprisingly, stimulation of the L2 roots has not given strong hip flexion. Responses have been stable. Some thresholds have varied, probably as a result of tissue encapsulation. The moment generated within each degree of freedom of the legs has been measured for each root, using a specially designed multimoment measurement apparatus. For several roots, a movement of lower threshold may be accompanied by a second movement of higher electrical threshold, suggesting that different muscles may have fiber populations that differ in their diameter or their location in the root. The use of stimulus forms that enable selective anodal block may, in the future, enable separation of two distinct movements from a single motor root.     

后路显微内窥镜手术治疗腰椎间盘突出症

目的：探讨后路经显微内窥镜椎间盘切除术(microendoscopic discectomy,MED)治疗腰椎间盘突出症的手术适应证、术中操作要点及并发症处理，方法：回顺性分析2000年3月～2002年3月应用、MED手术治疗的腰椎间盘突出症患者242例．男171例，女71例：年龄19—71岁，平均34岁。术前均行CT检查，常规扫描L3-S1三个椎间隙，48例术前行MR检查，检查结果为单节段椎间盘突出193例．双节段椎间盘突出46例，三节段椎间盘突出3例。手术切除单节段205例，双节段36例．三节段1例。结果：术后1-6d下床活动，平均2．2d，术后住院3～12d．平均5．2乱切口浅层感染1例，经换药后二期愈合，全部病例随访2-15个月．平均6个月．术后平均3．6周基本恢复正常生活和一般工作．恢复原工作率52.4％，接Macnab疗效评价标准．优183例、良44例、可13例、差2例，优良率94％。术中发生硬膜及神经根袖损伤6例．椎间隙定位错误1例～术后椎间隙感染1例．经卧床制动、理疗和抗生素治疗后痊愈。结论：严格掌握适应证、熟练的操作技术是减少MED手术并发症、提高其疗效的关键。     

后路椎弓根钉内固定治疗多节段胸腰椎骨折的临床观察

目的　探讨经后路椎弓根钉内固定的指征及远期疗效。　方法　经后路切开复位、椎弓根内固定术治疗多节段胸腰椎骨折 82例 ,随访时间 2～ 5年 ,平均 2 .8年 ,82例均于术前、术后、末次随访时、内固定取出前、后拍摄脊柱正侧位X线片和CT片。　结果　 (1 )本组 71例 (87%)为交通伤和高处坠落伤所致 ,致伤机制复杂 ,6 3例 (77%)合并其他损伤 ;(2 )脊柱活动改善率为77%;腰背痛改善率为 95 %;下肢疼痛改善率为 80 %。 (3)与术前相比 ,伤椎前缘高度平均矫正 5 5 .1 %,平均丢失 2 .1 %(P <0 .0 1 ) ;Cobb角平均矫正 2 5 .7° ,平均丢失 4 .4°(P <0 .0 1 )。　结论　采用椎弓根钉内固定技术治疗多节段胸腰椎骨折有利于恢复脊柱伤椎高度、生理弧度和神经功能以及消除腰腿痛 ,有较好的远期疗效 ;在警惕其他脏器合并伤的同时 ,可适当放宽手术指征。     

腰椎间盘突出症治疗前后X线片对比观察

目的：总结分析腰椎间盘突出症治疗前后的X线改变。方法：对诊断明确的32例腰椎间盘突出症患者，18例行保守治疗，14例行髓核摘除术并随访10-25年，对其X线片进行回顾性分析。结果：保守治疗者腰椎间隙变窄速度慢，程度轻，少数患者相邻椎小关节发生退行性骨关节病。髓核摘除术者椎间隙变窄速度快，程度重，发生相邻椎小关节退行性骨关节病者较前者多见。结论：腰椎间盘突出症治疗方法视病情而定，保守治疗仍是一种比较理想的治疗方法。     

椎弓根固定系统在腰椎退行性疾病治疗中的应用

目的 研究椎弓根固定器械在腰椎退行性疾病的应用指征、疗效和安全性。方法对121例应用椎弓根器械进行治疗的腰椎退行性疾病的患者进行随访。随访时间0．5～6．1年，平均3．1年。应用Suk标准进行影像学融合情况评估；VAS进行疼痛评估；以Oswestry功能丢失指数进行临床疗效评价。结果V AS(0～10分)评分：术前9．5～6．8(平均8．5)，术后0～5．3(平均4．1)；()swestrv：术前30～80(平均64)，术后0～72(平均38．5)。融合率：91．740A，；临床有效率：87．60％。结论 椎弓根器械在腰椎退行性疾病的手术治疗中具有提高融合率，促进症状改善，缩短康复时间的作用。同时应关注椎弓根器械的性能一价格比，严格掌握临床应用指征。     

AF钉棒系统经椎弓根固定治疗胸腰椎骨折脱位

目的 分析和评估轴形内固定(AF)的临床应用价值。方法 对42例胸腰椎骨折患者行AF内固定。每位患者术前均行X线、CT等影像学检查。术中按Megerl法置钉常规摄定位X线片。42例中39例获得随访，平均21个月，观察内固定及神经症状恢复情况。结果 术后cobb’s角平均改善23．2。压缩椎体高度均恢复40．2％，14例合并神经系统症状患者，12例有明显改进(2例Fmnkel A级无明显改善)。结论 AF钉具有创伤小、出血少、操作相对简单安全、固定节段少等优点，特别适用于胸腰椎骨折脱位后路减压和复位需要重建脊柱稳定性的治疗。     

特发性脊柱侧凸的前路矫形手术

目的评价前路矫形手术对特发性脊柱侧凸的治疗效果。方法回顾性分析术后随访时间超过1年的特发性脊柱侧凸34例,男5例,女29例;年龄8～17.5岁,平均15.7岁。侧凸类型包括PUMCⅠa型1例、Ⅰb型8例、Ⅰc型6例、Ⅱc1型4例、Ⅱd1型15例。采用前路三维矫形手术,内固定器械包括TSRH16例、MossMiami8例、CDH10例。术前、术后及随访时摄X线片,测量冠状面及矢状面Cobb角、躯干偏移、顶椎及下融合椎的旋转度、下融合椎与骶骨夹角,并观察有无假关节形成。结果全部病例随访12～63个月,平均21个月。术中出血量200～1200ml,平均255ml。融合3～7节椎体,平均4.42节。融合弯冠状面畸形矫正率平均为73.4%,矢状面手术前后Cobb角差异无显著性。7例胸腰段或腰椎后凸患者术前后凸平均11.9°,术后矫正为前凸6.8°。19例双弯患者术后上弯冠状面自动矫正率为39.5%(P<0.01);融合弯顶椎旋转改善率32%(P<0.01),下融合椎旋转亦有明显改善(P<0.05),上弯顶椎旋转无明显改善。凸侧Bending像融合弯Cobb角与术后比较差异有显著性(P<0.01)。单弯(PUMCⅠb型、Ⅰc型)者术后即刻躯干偏移增加7.3mm,1年后较术前改善7.5mm;双弯者术后躯干偏移持续改善。凹侧Bending像下融合椎与骶骨的夹角与术后比较差异无显著性。结论前路矫形融合术具有较强的冠状面     

后路全脊椎截骨矫形手术器械的设计和临床应用(附1200例报告)

[目的]研制一套专用于脊柱后凸、侧后凸畸形手术截骨矫形器械。[方法]该器械通过后方入路（常规器械切除脊椎后结构）经双侧椎弓根、椎体行楔形截骨，直到椎体前缘皮质下。[结果]使用该器械共手术矫正后凸及侧后凸畸形1200例，最高截骨平面T.水平，单病例最多截骨达4处，平均截骨2处，一处椎体截骨时间平均30min，出血约100ml，术中脊髓和神经根保护安全。[结论]后路全脊椎截骨矫形器械具有截骨规范、手术时间短、术中出血少、脊髓和神经根保护安全、截骨创面对合紧密、利于截骨创面愈合等优点。适用于各种原因导致的脊柱后凸畸形截骨矫正手术，显著降低术中和术后并发症：     

人工髓核置换治疗腰椎间盘突出症

介绍一种骨科新技术,人工髓核置换治疗腰椎间盘突出症。通过其适应证与禁忌证、型号大小和手术方法,结合作者手术经验和短期观察进行讨论,部分患者术后出现短暂的剧烈腰痛,口服药物后缓解。在人工椎间盘置换和椎间隙最终行融合之前,恢复脊柱节段的功能,是脊柱外科的发展趋势,人工髓核是一种选择。     

A model system for evaluating filing technique

The aim of this study was to develop a model system to demonstrate the pattern of load and how much is applied. A lower molar was mounted on a beam and attached to a mandibular phantom head jaw. A strain gauge fitted to the beam allowed loading of the molar to be recorded, during root canal preparation. Ten operators were asked to instrument the distal root canal; after preparation the operators were shown a graphical representation of the loads applied. This formed the basis of discussion and instruction in filing technique. The operators then repeated the filing. The results showed that prior to instruction operators used a push-pull motion, applying a constant lateral force to the canal wall. After instruction and discussion of the graphical representation of the loads applied the stroke rates used were slower and loads applied were higher (two-sample t-test, n=10, P<0.01). The experiment was repeated 1 year later and this showed that the change in technique had been retained. In conclusion, this model system allows visual feedback to the operator and can be used as an aid to teaching filing technique.