1.5T磁共振T2 mapping成像诊断腰椎间盘退行性变的价值

目的探讨1.5T磁共振T2 mapping成像在腰椎间盘退行性变之中的诊断价值。方法选择2018年1月—2019年1月在本院行1.5T磁共振检查的50例腰背疼痛患者当做研究对象,所有患者均进行矢状位T₁WI、T₂WI、横断位T₂WI、正中矢状位T2 mapping成像。以Pfirrmann标准作为依据,进行腰椎间盘分级,并对髓核、纤维环前缘和后缘T2值进行测量,分别对各级髓核及纤维环的前缘及后缘T2值进行对比,并对T2值、分级以及年龄之间的相关性进行分析,同时,选择15例患者时隔6个月进行第2次磁共振检查,对两次椎间盘T2值之间产生的差异进行对比。结果腰椎间盘各级髓核T2值中,Ⅳ级与Ⅴ级之间未见明显差异,无统计学意义,P>0.05,其余各级间均存在明显差异,有统计学意义,P<0.05;患者年龄与分级呈正相关,年龄与T2值呈负相关,T2值与分级呈负相关;15例患者前后两次检测中,椎间盘纤维环前缘、后缘、髓核T2值均不存在明显差异,无统计学意义,P>0.05。结论腰椎间盘退行性变采用1.5T磁共振T2 mapping成像进行检查,能够实现有效的定量评估,特别是髓核T2值可对Ⅰ~Ⅳ级椎间盘退行性变程度差异进行有效反映,值得应用。     

The management of radiculopathy,neurogenic claudication and cauda equina syndrome

Radiculopathy is a commonly encountered symptom in neurosurgical practice. This article discusses the clinical presentation, anatomy, pathophysiology and treatment of radiculopathy, neurogenic claudication and cauda equina syndrome.     

后路腰椎椎间融合内固定病人术后切口感染的影响因素分析

目的:探讨后路腰椎椎间融合内固定(PLIF)后切口感染的影响因素,并提出预防措施。方法:选取医院2016年6月—2019年6月收治的440例行PLIF术病人为研究对象,根据术后感染情况,分成感染组、非感染组,分析术后切口感染发生与临床特征的关系。经多因素Logistic分析切口感染的影响因素,并提出预防措施。结果:440例病人中16例(3.64%)发生切口感染,424例(96.36%)未发生切口感染。经单因素、多因素Logistic回归分析显示,年龄≥60岁、手术时间>180 min、术后导尿管留置时间≥3 d、术前住院时间≥3 d是切口感染的影响因素(P<0.05)。结论:PLIF术后切口感染与病人年龄、手术时间、术后导尿管留置时间、术前住院时间存在密切关联。护理人员可根据病人具体情况采取针对性措施,控制感染风险。     

The Lumbar Ligamentum Flavum Does Not Have Two Layers and Is Confluent with the Interspinous Ligament: Anatomical Study with Application to Surgical and Interventional Pain Procedures

Numerous authors over the years have reported that the lumbar ligamentum flavum has two layers. Our routine cadaveric dissections raised the question whether this understanding is correct, as we always have observed only one layer. Thus, the goal of this cadaveric study was to reevaluate the layers of the ligamentum flavum. Twenty lumbar levels from five fresh-frozen cadaveric specimens were used in this study. After dissection of the lumbar spine, the ligamentum flavum and interspinous ligament were exposed. Each lumbar level was transected through the zygapophyseal joint, and hematoxylin and eosin staining, Masson's trichrome staining and Verhoeff-van Gieson staining were performed. Continuation of the interspinous ligament and ligamentum flavum were observed invariably. There was no evidence of the existence of a two-layered ligamentum flavum. The lumbar ligamentum flavum does not consist of two layers, but is confluent instead with the interspinous ligament that attaches to the zygapophyseal joints. To convey this anatomy better, we suggest describing the lumbar ligamentum flavum as a structure that consists of interlaminar and interspinous parts. Precise knowledge of the ligamentum flavum's anatomy can be of clinical value, particularly when epidural anesthesia or lumbar puncture are performed. Clin. Anat. 32:34–40, 2019. © 2019 Wiley Periodicals, Inc.     

Response of the Axial Skeleton to Bipedal Loading Behaviors in an Experimental Animal Model

Many derived aspects of modern human axial skeletal morphology reflect our reliance on obligate bipedal locomotion. Insight into the adaptive significance of features, particularly in the spine, has been gained through experimental studies that induce bipedal standing or walking in quadrupedal mammals. Using an experimental animal model (Rattus norvegicus), the present study builds on earlier work by incorporating additional metrics of the cranium, employing quantitative methods established in the paleoanthropological literature, and exploring how variation in mechanical loading regimes impacts axial anatomy. Rats were assigned to one of five experimental groups, including “fully loaded bipedal walking,” “partially loaded bipedal walking,” “standing bipedally,” “quadrupedal walking,” and “no exercise control,” and engaged in the behavior over 12-weeks. From μCT data obtained at the beginning and end of the experiment, we measured foramen magnum position and orientation, lumbar vertebral body wedging, cranial surface area of the lumbar and first sacral vertebral bodies, and sacral mediolateral width. Results demonstrate that bipedal rodents generally have more anteriorly positioned foramina magna, more dorsally wedged lumbar vertebrae, greater articular surface areas of lumbar and first sacral vertebral bodies, and sacra that exhibit greater mediolateral widths, compared to quadrupedal rodents. We further document variation among bipedal loading behavior groups (e.g., bipedal standing vs. walking). Our experimental animal model reveals how loading behaviors and adaptations may be specifically linked, and implicates a potential role for developmental plasticity in the evolutionary acquisition of bipedal adaptations in the hominin lineage. Anat Rec, 2018. © 2018 American Association for Anatomy.     

经皮内镜椎间孔入路腰椎间盘切除术并发硬脊膜撕裂的综合处理及疗效分析

目的 探讨经皮内镜椎间孔入路腰椎间盘切除术（PETD）治疗腰椎间盘突出症并发硬脊膜撕裂的处理方法及预后。方法 回顾性分析2016年3月至2017年1月采用PETD治疗的236例腰椎间盘突出症的病例资料。结果 236例中，3例发生硬脊膜撕裂，发生率为1.3%(3/236)。2例术中诊断，其中1例术中转为显微镜下修补硬脊膜，1例术中未做处理；1例术后诊断，在显微镜下完成硬脊膜修补。3例随访12个月，末次随访时视觉模拟量表评分从术前8.0分降至1.7分，Oswestry功能障碍指数从82.1%降至17.8%，均无神经功能障碍等后遗症；改良MacNab评分2例为优，1例为良。结论 硬脊膜撕裂是PETD较为少见的并发症，应根据术中和术后情况，采取综合治疗措施，总体预后良好     

低分子肝素钙预防腰椎退行性疾病术后深静脉血栓形成的有效性和安全性

目的探讨低分子肝素钙预防腰椎退行性疾病术后深静脉血栓形成(DVT)的有效性和安全性。方法回顾性分析广安市广安区人民医院68例腰椎退行性疾病患者的临床资料,术后均采用抗凝预防血栓形成,按照术后预防DVT所采用方式的不同分为对照组和低分子肝素钙组。分析比较2组患者术后引流量、切口愈合情况、DVT发生率、皮下瘀斑情况、血小板数值、凝血功能、D-二聚体。结果术后2组患者引流量、切口愈合情况、皮下瘀斑情况、凝血功能相关指标比较,差异无统计学意义(P>0.05)。术前和术后1、10 d 2组患者血小板数量的变化差异无统计学意义(P>0.05)。DVT发生率2组患者比较差异有统计学意义(P<0.05)。术前及术后1 d 2组患者D-二聚体比较,差异无统计学意义(P>0.05);术后10 d,对照组患者D-二聚体显著增加,2组比较差异有统计学意义(P<0.05)。结论腰椎退行性疾病术后使用低分子肝素钙进行抗凝,可以显著降低DVT的发生率,具有良好的安全性。     

Multifidus muscle fatty infiltration as an index of dysfunction in patients with single-segment degenerative lumbar spinal stenosis: A case-control study based on propensity score matching

The multifidus muscle morphology and its relation to the function of patients with degenerative lumbar spinal stenosis (DLSS) remains unclear. This study aimed to investigate the multifidus muscle morphology in patients with DLSS and to determine its relations to the patients function. Sixty-two patients with single-segment DLSS at L4-5 and sixty control patients with non-spinal-derived low back pain were retrospectively enrolled and further matched based on propensity scores. The Oswestry Disability Index (ODI) and bodily pain using the Short-Form Health Survey were evaluated. The cross-sectional area (CSA), CSA of fatty free (CSAF), and fatty infiltration rate [FIR; i.e., (1- CSAF/CSA) × 100%] of the multifidus muscle were measured on magnetic resonance images using ImageJ software. Adjustment for confounders was performed using generalized linear models.The FIR at L5-S1 in controls was statistically significant but slightly less than the DLSS group. The between-groups difference was 5% (p < 0.001), and 2.8% (p = 0.036) in the complete and matching cohorts, respectively, after adjustment. Statistically significant differences were not observed in other multifidus muscle parameters between the groups. FIR > 20% at L5-S1 was independently associated with ODI ≥ 41 in patients with DLSS [Retaining demography as control block or not, Odds ratio (OR) = 8.4, p = 0.023; OR = 12.3, p = 0.030]. The multifidus muscle at L5-S1 demonstrated slightly greater fatty infiltration in patients with L4-5 single-segment DLSS than controls. Significant fatty infiltration in the multifidus muscle at L5-S1 may be correlated with poor function in patients with L4-5 single-segment DLSS.