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?     

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。     

老年退行性腰椎管狭窄症的手术疗效分析

目的:探讨老年退行性腰椎管狭窄症患者减压手术的疗效。方法:1997年1月～2003年12月收治的70岁以上且获得2～6年随访的退行性腰椎管狭窄症患者106例,男49例,女57例;年龄70～82岁,平均76.3岁;病史4～10年,平均6.7年。42例并存1种内科疾病,55例并存两种或以上的内科疾病。均经过正规保守治疗无效。术前联合内科诊治并存的内科疾病。95例行单纯全椎板切除减压术;11例采用椎板减压、椎弓根固定、椎间植骨融合术,对手术疗效进行回顾性分析。结果:无围手术期死亡病例。出现并发症22例次,经对症及内科联合处理后好转。单纯减压组术后3周配戴腰围下床活动;内固定组术后3～5d下床活动。平均随访3年10个月,Oswestry评分从术前59.64±11.07分改善至16.81±7.36分。所有患者连续行走从术前不足15min改善到至少30min。95.2%患者自诉生活质量明显提高。结论:老年退行性腰椎管狭窄症患者在积极控制并存内科疾病的基础上,手术减压治疗对神经功能的恢复有重要作用,可获得较满意的临床疗效。     

下腰椎失稳合并椎管狭窄症的手术治疗

目的：观察下腰椎失稳合并椎管狭窄症患者经椎弓根螺钉系统及椎体融合器治疗的效果。方法：采用后路减压，椎弓根螺钉系统内固定，椎体间融合器BAK融合。结果：术后随访1年一4年3个月(平均2年4个月)，椎体间骨性融合率1年89．6％，2年2个月100％，临床症状消失满意率92％。结论：采用椎管减压、椎弓根螺钉系统加椎间融合器固定，可使滑脱失稳的椎体部分或全部复位，保证脊柱骨性融合，达到脊柱稳定、解除症状的目的。     

Role of technetium-99m planar bone scanning in the evaluation of low back pain

The records of 1018 patients with low back pain in a tertiary spine referral practice were reviewed. One hundred thirty-nine out of 1018 (13.6%) underwent technetium-99m planar bone scanning as part of their investigation. Seventy-three out of 139 scans (52%) showed increased uptake in some area, but only 27 out of 139 (19.4%) showed increased uptake specifically in the low back. Scans consistently yielded no findings with reference to the back when the prescan diagnosis was spinal stenosis, lumbar pain syndrome, herniated nucleus pulposus, or postlaminectomy syndrome. Some scans gave positive findings in patients with a diagnosis of degenerative disc disease, pseudarthrosis, spondylolisthesis, fracture, infection, metabolic disorder, or tumor. Positive scans were generally obtained early after presentation (within 3 months) and negative scans obtained later (after 6 months), suggesting that clinical suspicion is still the main indication for early scanning. Planar bone scanning was helpful in both diagnosis and therapeutic decisionmaking in many conditions.     

肌电图对腰神经后根节段定位作用的实验研究

目的:探讨应用肌电图行大鼠腰神经后根节段定位的方法。方法:通过电生理的方法,依次电刺激L3￣L5脊神经后根,分别记录大鼠双侧下肢主要肌肉的肌电图像,测量最早出现的感觉神经动作电位(SNAP)最大波幅值。结果:刺激L3脊神经后根,于股四头肌记录到的波幅峰值(480.8±255.9μV)显著高于其它各组肌肉(P<0.01)。刺激L4脊神经后根,于下肢四组肌肉记录到的CMAP最大波幅平均值均>100μV,其中在股四头肌(305.2±131.5μV)、胫骨前肌(340.2±310.4μV)记录到的波幅峰值显著高于在股二头肌(142.4±144.7μV)、腓肠肌(138.2±127.6μV)记录到的波幅峰值(P<0.01)。刺激L5脊神经后根,于股二头肌(377.5±264.4μV)、腓肠肌(168.4±126.7μV)记录到的波幅峰值显著高于其它各肌群记录到的波幅峰值(P<0.01)。结论:电刺激不同脊神经后根,在大鼠下肢不同肌肉记录到的SNAP的波幅峰值存在差异,综合分析记录到的SNAP的波幅峰值,可作为腰神经后根节段定位的参考。