Inter-rater Accuracy and Reliability of a Palpation Protocol of the C7 Spinous Process Comprising a Combination of 3 Traditional Palpation Techniques

ObjectiveThe purpose of this study was to determine the accuracy and intrarater reliability of a palpatory protocol based on a combination of 3 palpatory methods to identify both the C7 spinous process (C7 SP) and the factors that affect the errors and inaccuracy of palpation.MethodsTwenty-five women between the ages of 18 and 60 years were submitted to a palpation protocol of the C7 SP, and a radiopaque marker was fixed on the skin at the possible location of the vertebrae. A radiograph and a photograph of the cervical spine were obtained in the same posture by a first rater. A second rater performed the same palpation protocol and took a second photograph. The accuracy and measurement error of the palpation protocol of C7 SP were assessed through radiographic images. The inter-rater reliability was estimated by the interclass correlation coefficient and assessed using photographs of each rater. The Pearson's correlation coefficients (r), the Fisher exact test, and the χ² test were used to identify the factors associated with the error and inaccuracy of palpation.ResultsAccuracy of the C7 palpation was 76% with excellent reliability (interclass correlation coefficient = 0.99). There was a moderate correlation between weight and the measurement of palpation error (r = –0.6; P = .003). One hundred percent of inaccuracy palpation was related to the increased soft-tissue thickness (P = .005) in the cervical region.ConclusionThe palpation protocol described in this study was accurate and presented excellent reliability in identifying the C7 SP. Increased weight and dorsocervical fat pad were associated to error and palpation inaccuracy, respectively.     

寰椎Jefferson骨折伴横韧带损伤的诊治

目的 分析总结寰椎Jefferson骨折伴横韧带损伤的诊断和治疗。方法 1995年3月-2005年3月收治26例寰椎Jefferson骨折伴横韧带损伤患者。其中新鲜骨折20例，陈旧性骨折6例。所有患者均伴有不同程度的横韧带损伤，23例有神经损害表现。X线检查显示寰椎弓环及侧块不同部位骨折，寰齿间距（ADI）为4．7mm。5例行非手术治疗，其余21例行颈椎后路枕颈融合术或寰枢椎融合术治疗。结果所有患者术后获6～24个月（平均15个月）随访，21例手术治疗患者术后临床症状缓解；5例非手术治疗患者中，4例成功，另1例失败再行颈后路寰枢椎融合术治疗，术后疗效满意。结论 寰椎Jefferson骨折伴横韧带损伤患者的临床表现主要取决于韧带断裂后寰椎前脱位的程度以及是否造成脊髓压迫，诊断以ADI为主、并结合外伤史及临床表现。对于可能存在寰枢椎不稳或已有横韧带损伤且存在典型神经症状的患者，应早期行寰枢椎融合术或枕颈融合术治疗。     

经皮穿刺椎体成形术治疗合并肺气肿的胸椎压缩性骨折

目的 探讨合并严重肺气肿的胸椎压缩性骨折进行经皮穿刺椎体成形术的技术特点和治疗效果。方法 7例(10个椎体)合并严重肺气肿并且透视椎体显示不清的胸椎骨质疏松椎体压缩骨折患，侧卧位在CT结合C型臂透视引导下进行经皮穿刺椎体成形术。术前、术后2d和随访时分别测定疼痛强度评分、止痛药使用和活动能力评分。随访2-8个月，平均5个月。结果 7例皆顺利完成手术，注射骨水泥的量平均2．2ml／椎体(1．0～4．0m1)，无临床并发症，手术时间2—3．5h／例。疼痛强度评分值术后2d比术前平均减低3．9，随访时进一步下降0．2—2．9，活动能力和止痛药使用术后均明显改善。结论 合并肺气肿的胸椎压缩性骨折患行经皮穿刺椎体成形术治疗前应进行骨折椎体透视检查，显示不清选择侧卧位在CT结合C型臂透视引导下穿刺注射可获得良好疗效。     

中下段颈椎的应力松弛特性及前、后路手术对其的影响

目的 研究中下段颈椎的应力松弛特性，并评估椎间盘切除植骨术与椎板切开术对其影响。方法 6例新鲜尸体完整颈椎及手术后颈椎，在模拟生理状态下进行屈曲及伸展位的应力松弛实验。结果 在恒应变条件下，绘制术前及不同术式后的中下段颈椎的应力松弛函数及曲线；术后的中下段颈椎的应力和初始化应力比值G(t)比术前明显增大，前路椎间盘切除植骨术后的G(t)值比椎板切开术大，两者均有统计学意义。结论 在恒应变条件下，颈椎具有快速应力松弛敏感性，屈曲位比伸展位大。椎板成形术及颈椎前路椎间盘切除植骨术都使颈椎的应力松弛能力减弱，前路椎间盘切除植骨术的影响更大。     

Preliminary findings on the effect of load-carrying to the structural integrity of the cervical spine

Summary Carrying loads on the head is a common practice in rural Zimbabwe. Headloading imposes a considerable amount of strain to the axial skeleton. The cervical spine, being the most cranial and mobile part of the vertebral column, may be susceptible to spondylosis or disc degeneration in headloading. Age as well as the effects of intrinsic factors on cervical spondylosis have been well documented. However, studies on the effect of extrinsic weight bearing to spondylosis on the cervical spine are lacking. In this study, the effect of headloading on the pattern of spondylosis attributed to aging was examined. Results indicated that age led to significant degeneration of the fifth intervertebral disc space (P<0.05) as well as significant straightening of the lordotic curve (P<0.01). Load carrying seems to accentuate the straightening of the curve (P<0.001). The results also suggest that headloading creates a shift in the degeneration from the fifth intervertebral disc space to higher levels. It is concluded that carrying heavy loads on the head alters the pattern of degenerative changes of the cervical spine.

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Etude préliminaire des effets des charges lourdes sur l'intégrité structurale de la colonne cervicale

Résumé Porter de lourdes charges sur la tête est une pratique habituelle au Zimbabwe dans les zones rurales. Le port céphalique de charge impose des contraintes considérables au squelette axial. La colonne cervicale, portion crâniale et mobile de la colonne vertébrale, peut présenter une cervicarthrose ou une altération discale en raison du port de charges sur la tête. L'âge et les facteurs intrinsèques déterminant une cervicarthrose ont été bien étudiés. Cependant, l'action éventuelle d'un poids supplémentaire contribuant à la genèse d'une cervicarthrose n'a pas été étudiée. Dans cette étude, les effets du port céphalique de charge sur l'importance d'une cervicarthrose attribuée au vieillissement, sont examinés. Les résultats indiquent que le vieillissement aboutit à une altération significative du 5ème espace intervertébral (P<0,05) ainsi qu'à un redressement significatif de la lordose (P<0.01). Le port de charge semble accentuer le redressement de la courbe (P<0,001). Les résultats suggèrent également que le port de charge sur la tête réalise un transfert des lésions du 5ème espace intervertébral vers des niveaux sujacents. On en déduit que le port de lourdes charges sur la tête modifie l'aspect des atteintes dégénératives de la colonne cervicale.

     

AF系统内固定治疗胸腰椎爆裂型骨折

为评价AF系统内固定治疗胸腰椎爆裂型骨折的疗效。应用AF系统内固定结合椎管减压、植骨治疗32例胸腰椎爆裂型骨折。结果32例中全部充分减压,固定可靠,神经恢复好转率达75%。结果表明,AF系统内固定治疗胸腰椎爆裂骨折是目前较为理想的疗法。     

长圆针治疗继发性腰椎间盘脱出综合征1396例止痛疗效观察

目的:探讨治疗继发性腰椎间盘脱出综合征疼痛的新疗法.方法:将1396例继发性腰椎间盘脱出综合征患者用经筋辨证方法,循足三阴、三阳经筋查取结筋病灶点,采用长圆针以解结法治疗.结果:治愈(完全止痛)1145例,占81.7%;好转227例,占16.2%;无效29例,占2.1%.有效率97.9%.结论:长圆针治疗继发性腰椎间盘脱出综合征具有良好的止痛效应.     

Clinical study on the treatment of subluxation of the small joint of the cervical vertebrae by acupuncture plus Tuina

观察针推结合治疗颈椎小关节错缝的临床疗效.将178例患者随机分成针刺组、推拿组和针推组进行对比观察.结果针推组痊愈率68.8%,高于针刺组27.8%和推拿组28.6%,经统计学处理(P＜0.01),有显著性差异.针推结合治疗本病可使疗效互增,相得益彰.     

Acupuncture treatment of 32 cases of lumbar intervertebral disc protrusion

Yaoyangguan (GV 3), Shiqizhui (Ex-B 8) and Yanglingquan (GB 34) were selected as main points and a three-part needle insertion technique was used to treat 32 cases of lumbar intervertebral disc protrusion. The curative rate was 96.9%. Deep puncture is the key to the treatment. Author: Chen Feng(1962-), male, junior consultant doctor Translator: Wang Si-you     

穴注野木瓜治疗腰椎骨质增生108例疗效观察

方法：采用肾俞穴位注射野木瓜注射液治疗腰椎骨质增生108例，并没针刺对照组52例进行临床对照观察。结果：穴位注射有效率98％，对照组有效率85％。结论：野木瓜注射波穴位注射治疗腰椎骨质增生有显著疗效。