Detailed pathological changes of human lumbar facet joints L1–L5 in elderly individuals

Facet joints play an important role in intervertebral load transmission and are crucial for rotational kinematics. Clinically, the role of facet joints as a possible source of low back pain is seen as controversial and at present is not sufficiently investigated. In this study, human lumbar facet (zygapopyhysial) joints from donors with advanced age were analyzed macroscopically, for degenerative changes. The aim was to determine the extent and morphology of degenerative changes in these joints. Lumbar facet joints (L1–L5) of 32 donors were studied (mean age 80.1±11.2 years). Joint capsules were carefully removed and joint surfaces (5 zones) examined using magnifying glasses and probes. In the result, the majority of facet joints showed cartilage defects of varying extent. Defects were located mostly at the margins of the articular surface, the central zone being relatively well preserved. Defect localization was different between superior (most cartilage defects in superior zone) and inferior (most defects inferiorly) facets. Further, defects were more severe caudal (level of L5) and in older persons. Osteophytes were present in up to 30%, located mostly at the latero-dorsal enthesis of the joint capsule on the superior facet. In conclusion, most margins of the articular facets are subject to degenerative changes in the lumbar spine of elderly persons, the topographical pattern being different in superior and inferior facets. This observation can be explained by the segmental motion patterns during extension/flexion movements of the facets. Sometimes, due to the marginal extension, it is obvious that not all changes can be assessed by CT or MRI.     

彩色多普勒超声诊断老年性退行性心瓣膜病的临床意义

目的 :探讨彩色多普勒超声诊断老年性退行性心瓣膜病的临床应用价值。方法 :收集经彩色多普勒超声诊断为老年性退行性心瓣膜病 36 0例的超声资料和临床资料 ,总结分析其病变瓣膜的声像图特点、彩色多普勒血流情况及与年龄的相关性。结果 :老年性退行性心瓣膜病多数发生在主动脉瓣 ,其次是主动脉瓣 +二尖瓣、二尖瓣。结论 :彩色多普勒超声诊断老年性退行性心瓣膜病方法简便、准确 ,给临床明确诊断及治疗提供重要的信息。     

影响胸椎后凸的多因素分析

[目的]研究胸椎后凸与性别、年龄、椎体和椎间盘形态的关系。[方法]回顾性研究、收集61例样本的性别、年龄资料和胸椎MRI片。在计算机上测量椎体、椎间盘前后缘的高度和Cobbs角,以椎体和椎间盘前后缘的高度比值代表椎体和椎间盘的形态,Cobbs角代表胸椎后凸。通过Pearsons相关分析和逐步回归分析研究他们之间的相关性。[结果]椎体形态与胸椎后凸的相关性比较大,相对来说椎间盘与胸椎后凸的相关性则比较小。女性81%的胸椎后凸与椎体和椎间盘的形态有关。男性72%的胸椎生理性后凸与椎体和椎间盘的形态有关。[结论]正常胸椎后凸是由椎体和椎间盘的形态共同决定的,特别是女性胸椎后凸与椎体和椎间盘形态的关系更加密切。     

先天性后侧半椎体切除术治疗角形脊柱后凸畸形

目的探讨先天性后侧半椎体切除术治疗角形脊柱后凸畸形的适应证、手术方法及临床效果. 方法采用该方法手术治疗角形脊柱后凸25例,经后路暴露双侧椎板,自双侧分离暴露关节突外侧和横突, 切除横突.沿椎弓根自骨膜下向前分离, 暴露多余的半椎体, 切除多余的一节椎弓和后侧半椎体,自后路行双侧弓根螺钉加压棍固定. 结果本组无脊髓损伤、感染等术后并发症发生.20例随访5～10年, 远期效果好; 3例随访1年以上, 矫正效果良好; 2例术后尚未及1年, 正在随访中.Cobb's角从术前平均68°降至术后平均11°. 结论先天性后侧半椎体切除术的年龄范围为8～22岁,年龄越大越趋向于作全脊柱截骨术.     

特发性颈椎后凸畸形的手术治疗

目的 :明确颈椎前路手术治疗特发性颈椎后凸畸形的可行性和局限性。方法 :本文对 14例颈椎特发性后凸畸形患者采取手术方法进行治疗 ,所有患者均采用颈椎前路椎间盘切除减压 ,椎间隙植骨和前路钢板内固定。结果 :手术后患者临床体征明显改善 ,颈椎后凸畸形由手术前平均 -15 6°矫正为手术后平均 -6 4° ,矫正效果明显 ;手术后患者的短期随访表明颈椎矫正度数在随访中没有丢失。结论 :前路手术 ,延长颈椎前柱能够矫正颈椎的后凸畸形 ,改善临床症状和体征     

椎弓根螺钉内固定及植骨融合治疗退行性腰椎滑脱的临床疗效评价

目的　评价腰椎管减压、后外侧植骨和椎弓根螺钉内固定治疗退行性腰椎滑脱的临床疗效。方法　 1993年 1月～ 2 0 0 2年 9月对 74例腰椎退行性滑脱的患者行腰椎管减压、后外侧植骨和椎弓根螺钉内固定 ,采用的椎弓根内固定技术包括Dick 8例、Steffee 10例、RF 9例、Socon 2 5例、Tenor 2 0例、Moss Miami 2例。滑脱水平在L4的患者有 4 4例、L3 有 9例、L5有 16例 ,两节水平的滑脱有 5例。Ⅰ°滑脱 37例 ,Ⅱ°31例 ,Ⅲ°6例。患者平均年龄为 5 3.6岁 (30～ 79岁 )。根据手术前、后日本骨科协会 (TDA)评分评价临床症状改善的程度。结果　平均随访时间为 4 4个月 (12～ 10 4个月 ) ,所有患者最后随访的JOA评分中客观症状为 (6 .7± 1.0 )分 ,临床体征为 (4 .7± 1.1)分 ,日常活动为 (11.8± 1.9)分 ,总评分为 (2 3.0± 2 .5 )分。手术前、后的JOA评分比较 ,术后主观症状改善 70 % ,临床体征改善 6 8% ,日常活动改善 77%。根据患者的年龄分为A组 (30～ 39岁 )、B组 (4 0～ 4 9岁 )、C组 (5 0～ 5 9岁 )、D组 (≥ 6 0岁 ) ,以JOA的评分结果 >2 5分定为满意 ,A、B、C、D组的满意率分别为91%、75 %、6 9%、6 1%。结论　椎板减压、后外侧植骨融合和椎弓根螺钉内固定是治疗不稳定腰椎滑脱的一种有效方法 ,临床疗效     

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。     

Osteoporosis and Back Pain among the Elderly

Questionnaire responses from 120 men and 337 women over the age of 50 years were studied to determine the prevalence of back pain among the elderly. In order to gain a rough indication of the back pain among elderly women which might be due to osteoporosis, the prevalence was compared in the two sexes. The prevalence of back pain without radiation to the legs and concomitant morbidity was found to be similar among men and women up to the 70–79-year age-group. After this age the prevalence was higher in women. Those with exceptional loss of body height or kyphosis had a high prevalence of back pain, while those who had sustained previous hip or radius fractures did not. There was increasing prevalence of back pain among women with increasing number of previous fractures. The study gives little indication of serious morbidity of osteoporosis in the form of back pain before very old age.