椎弓根钉内固定系统治疗胸腰椎骨折合并脊髓损伤

目的 探讨椎弓根钉内固定系统治疗胸腰段骨折合并脊髓损伤的效果.方法 对46例胸腰段骨折合并脊髓损伤的患者,进行椎板切除、椎管减压、椎弓根钉系统内固定加植骨术,并对术后神经功能恢复、椎体高度恢复及椎管截面积进行分析.结果 随访8～36个月,平均20个月,神经功能平均恢复1.6级,椎体高度平均恢复到正常高度的95%以上,无一例术后神经功能障碍加重.结论 早期椎板切除、椎管减压、椎弓根钉系统内固定是治疗胸腰段骨折合并脊髓损伤有效的手术方式.     

USS椎弓根钉系统结合后路椎体间及后外侧植骨融合术治疗下腰椎不稳定的临床体会

目的探讨后路椎体间植骨融合术治疗下腰椎不稳定的手术技术并评价其应用价值。方法对明确诊断为下腰椎不稳的患者进行后正中人路下的椎管狭窄减压手术，椎弓根螺钉植入并行椎间隙撑开，双侧切除椎间盘保留侧方以及前方的纤维环，刮除终板的软骨层，植入足量的松质骨以及三面皮质骨的髂骨块，并行侧后方植骨，椎弓根螺钉系统加压固定。结果28例获得手术后3个月随访，原有的神经压迫症状大部恢复，行走距离增加最为明显。椎间高度术前2．7～6．8mm，平均高度4．1mm，术后椎间高度10．8～14．4mm，平均11．6mm。在3个月随访时平均高度为10．1～13．4mm，平均11．3mm。椎间孔3个月后较术前增加6mm。27例植骨融合。1例植骨块吸收，但症状改善。最常见的并发症为脑脊液漏和神经根牵拉刺激，最终缓解。结论后路椎体间及后外侧植骨融合术结合椎弓螺钉系统固定治疗下腰椎不稳能够达到充分减压，即刻的腰椎稳定性的重建以及长期骨性融合的治疗目的。     

保留刺突及部分椎板的椎管减压术治疗腰椎管狭窄症

目的：探讨一种既能充分减压又能维持腰椎稳定的治疗腰椎管狭窄的手术方法。方法：32例60岁以上的病人采用保留棘突和部分椎板的椎管减压术,根据术后症状改善程度来评价减压的彻底性。根据术前术后动态X片来评价腰椎稳定性。结果：手术后症状完全改善29例,优良率为90．6％,术后发生椎体滑脱3例,占9．3％,讨论：保留棘突和部分椎板的椎管减压术是一种既能充分减压,又能达到椎体稳定的治疗腰椎管狭窄的手术方法。     

椎弓根钉棒系统治疗胸腰椎不稳定骨折23例临床观察

目的观察椎弓根钉棒系统治疗胸腰椎不稳定骨折的临床疗效。方法对23例胸腰椎不稳定骨折患者行椎弓根钉内固定,横突间或小关节间隙植骨、椎板间植骨,其中10例行全椎板切除减压、探查脊髓、椎管内骨块复位。术后对所有病例行胸腰椎正侧位X线检查,从X线侧位片判断螺钉与椎体骺板的成角、进针的位置与深度,观察伤椎椎体高度恢复情况以及有无后凸。结果术后随访6-24个月,平均13个月,无内固定失败者,椎间植骨融合良好,椎体前缘高度与正常高度的比值较术前明显改善,脊髓神经损伤者术后神经功能均有不同程度恢复。结论椎弓根钉棒系统治疗胸腰椎不稳定骨折疗效良好,可早期恢复正常椎体序列,重建脊柱的稳定性,解除对脊髓及神经的压迫。     

65岁以上老年人腰椎管狭窄症手术治疗的临床分析

目的 探讨老年人腰椎管狭窄症手术治疗的可靠性、手术方法及手术后效果。方法 回顾性分析1990年1月至2005年6月我院收治的65岁以上老年腰椎管狭窄症患者304例，其病程3~360个月，平均139．2个月，手术方法主要为单纯全椎板切除减压术、多节段椎板开窗减压术、全椎板及侧隐窝神经根管减压＋椎弓根螺钉固定术＋椎体间或（和）横突间植骨术。结果 术后264例恢复良好或优，优良率86．8％；34例感觉与术前比，变化不大；有6例较术前加重；无术中死亡患者。结论 老年患者多病程长、术前各种并存症多，掌握手术适应证应慎重，术前详细检查并积极地处理并存症、多科共同协作是手术成功的关键。手术应在充分的减压基础上尽量减少损伤，最短时间完成手术，根据实际合理的内固定促进植骨融合。术后积极的功能锻炼、早期的下床活动是保证手术效果、减少术后并发症的关键。     

单枚螺纹状椎间融合器联合椎弓根螺钉系统内固定治疗峡部裂性腰椎滑脱症

采用后路椎板切除减压、单枚螺纹状椎间融合器（TFC）后斜向植入联合椎弓根螺钉系统内固定治疗峡部裂性腰椎滑脱症22例。结果优15例，良5例，可2例，差0例；椎间植骨融合率为100％；椎间隙高度由术前的6.0mm恢复至术后的11．6mm，至随访时无明显椎间隙高度丢失。认为单枚椎间融合器联合椎弓根螺钉系统内固定是治疗峡部裂性腰椎滑脱症的有效方法。     

老年退行性腰椎滑脱症的外科治疗

目的 探讨老年人退行性腰椎滑脱合并椎管狭窄症的外科治疗方法及远期疗效。方法 对近5年来23例老年退行性腰椎滑脱并发椎管狭窄者分别进行了椎板减压、部分病人附加了内固定或椎体间植骨融合术,评估了手术疗效和恢复活动后继续滑脱的可恿生。结果 随访8个月－4年（平均1年3个月）。术前腿痛麻17例均获消失或明显缓解。术前双下肢无力不能站立行走者6例,术后2－3个月均能行走,生活自理,其中5例尿便功能障碍者也恢复括约肌功能。术后X线平片证实,继续滑脱者仅2例,滑脱度增加不足5％。结论 老年人因合并骨质疏松症、心脑等疾病,手术不宜过大,不宜附加内固定和另外取骨植骨融合,因而增加手术时间和术后卧床时间。有限地扩大椎板减压和间盘切除对缓解神经受压及马尾神经损伤有明显疗效。     

前路手术治疗前中柱不稳定型胸腰椎爆裂骨折

目的探讨前路手术治疗前中柱不稳定型胸腰椎爆裂骨折的治疗效果。方法回顾性分析2009年10月～2010年12月我科前路手术治疗前中柱不稳定型胸腰椎爆裂骨折患者37例。采用Frankel标准评定术后神经功能恢复情况,影像学检查比较伤椎Cobb角的矫正及丢失,评估椎管内减压范围、椎体前缘高度恢复情况、植骨块位置及愈合情况。结果手术时间150—280min、平均220min,出血量600—1200ml、平均850ml。术后无一例出现神经症状加重,术前不完全神经损伤的25例患者术后神经功能均恢复1级或1级以上。术后伤椎Cobb角后凸角度平均矫正7．8°,椎管内骨性占位为0,椎体前缘高度平均矫正68．8mm,脊柱序列和生理曲度基本恢复正常。32例随访6—20个月、平均13．8个月,x线片未见明显的矫正度丢失、假关节形成或内固定断裂及松动,植骨处均获得骨性融合。结论采用前路手术治疗前中柱不稳定型胸腰椎爆裂骨折是一种安全、有效的方法。     

30例爆裂型、脱位型腰椎骨折手术效果分析

目的提高爆裂型、脱位型腰椎骨折的手术疗效及安全性。方法对30例爆裂型、脱位型腰椎骨折取后路椎弓根螺钉系统复位固定、全椎板切除椎管减压及植骨融合术治疗,根据CT测定的椎体旋转角度确定螺钉置入角度,个体化置钉。结果术后近远期疗效满意,椎管面积扩大,神经症状改善。结论后路椎弓根螺钉系统复位固定、全椎板切除椎管减压及植骨融合术治疗严重爆裂型和骨折脱位型腰椎骨折疗效确切,术中应根据旋转角度确定螺钉置入角度。     

颈前路椎体次全切减压植骨内固定术治疗双节段脊髓型颈椎病中远期随访

目的:回顾分析颈前路椎体次全切减压植骨内固定术治疗双节段脊髓型颈椎病的中远期疗效.方法:回顾我院自2008 ～ 2011年采用颈前路椎体次全切减压植骨内固定术治疗双节段脊髓型颈椎病患者43例的临床资料.采用SPSS18.0软件对患者术前、术后、末次随访时JOA评分、颈椎生理弯曲与椎间高度比较进行统计学分析.结果:平均随访3.5年(2～5年),所有患者术前术后JOA评分术前平均8.5±1.4分,术后JOA评分12.5±1.3分,末次JOA评分14.5±1.3分.患者术前术后JOA评分差异有统计学意义(P＜0.05);末次随访与术前JOA评分差异有统计学意义(P＜0.05),神经改善率优良率83.72％,患者术后颈椎生理曲度较术前有明显恢复,患者术前术后颈椎生理弯曲差异有统计学意义(P＜0.05),末次随访与术前颈椎生理弯曲差异有统计学意义(P＜0.05),而且患者术后椎间高度较术前有明显改善.结论:颈前路椎体次全切减压植骨内固定术治疗双节段颈椎病能够明显改善患者神经功能,稳定颈椎,恢复颈椎生理弯曲度及椎间高度,而且中远期疗效确实.     

前路病椎切除植骨内固定治疗脊柱结核

目的　探讨经脊柱前路结核病灶清除的同时植骨内固定的可行性和必要性 ,以及对脊柱结核的治疗效果。方法　 1998年 2月～ 2 0 0 0年 8月采用脊柱前路病椎切除加植骨 ,并采用Orion或Z plate钢板进行椎体固定。共治疗 12例脊柱结核 ,观察植骨融合及矫正畸形情况和结核病灶愈合情况。结果　经平均 10个月的随访 ,12例患者脊柱结核均治愈 ,植骨与受骨区全部骨性融合 ,融合时间平均为 5 8个月 ,后凸矫正角度平均 16°。全组病例切口均一期愈合。无手术并发症。结论　本方法可经脊柱前路作较彻底的病灶清除 ,并较好地进行脊柱矫形和椎管减压 ,完成脊柱稳定性重建 ,有利于患者早期离床活动和脊柱结核治愈率的提高。     

Wallis棘突间动态内固定治疗老年节段性腰椎管狭窄的短期临床效果

目的 探讨后路椎管减压和Wallis棘突间动态内固定治疗老年节段性腰椎管狭窄症的术后短期临床效果。方法回顾性分析2008年1月至2010年12月在解放军空军总医院行后路椎管减压、Wallis棘突间动态内固定治疗的25例腰4．5节段椎管狭窄症的老年患者。男11例,女14例;平均年龄65岁。所有患者随访期均≥6个月。记录所有患者术前、术后3天、术后1个月、术后6个月Oswestry功能障碍指数（ODI）评分及视觉模拟评分（VAS）评分,测量手术节段（腰4-5）和邻近节段（腰3-4、腰 5-骶1）椎间隙与椎间孔高度。记录所有患者术中、术后并发症。结果25例患者均在椎管减压后顺利置人Wallis系统。术中、术后未发生手术相关并发症。所有患者术后临床症状均有缓解,术后3天、1个月、6个月时ODI评分和VAS评分与术前比较,差异均有统计学意义（P〈0．01）。术后1个月、6个月邻近节段（腰3-4、腰 5-骶1）椎间隙与椎间孔高度与术后3天比较,差异均无统计学意义（P〉0．05）。结论椎管减压和Wallis棘突间动态内固定治疗老年节段性腰椎管狭窄症的术后短期随访临床效果满意,Wallis系统可有效维持手术节段椎间隙及椎间孔高度,短期随访未发现引起邻近节段明显退变。     

单侧开门外侧块螺钉固定植骨治疗颈脊髓压迫症

目的 探讨单侧开门外侧块螺钉固定植骨术治疗颈脊髓压迫症的临床疗效.方法 自2004-02～2008-06采用单侧开门外侧块螺钉固定植骨术治疗颈脊髓压迫症26例,男18例,女8例;年龄51～67岁,平均58岁.26例中有22例为多节段脊髓型颈椎病(3个或3个节段以上),其中10例合并发育性椎管狭窄症(6例合并动力性椎管狭窄症,3例合并后纵韧带骨化症,1例为外伤性);4例为颈椎管内肿瘤.随访9个月～2年2个月,平均1年8个月.结果 疗效评定标准参照日本整形外科协会(JOA)评分标准,优8例,良15例,可2例,差1例,优良率为88.5%.无一例出现血管损伤或内固定物断裂并发症,1例脊膜瘤因肿物过大术后出现脊髓再灌注损伤表现,经积极治疗好转,生活可自理.结论 该法适用于需要从后方入路进行减压的颈脊髓压迫症,疗效肯定.其优点是手术相对安全,在彻底减压的同时进行坚强的内固定,尤其适用于伴有节段性不稳的脊髓型颈椎病.     

MRI morphometric characterisation of the paediatric cervical spine and spinal cord in children with MPS IVA (Morquio-Brailsford syndrome)

Nearly all children with MPS IVA develop skeletal deformities affecting the spine. At the atlanto-axial spine, odontoid hypoplasia occurs. GAG deposition around the dens, leads to peri-odontoid infiltration. Transverse/alar ligament incompetence causes instability. Atlanto-axial instability is associated with cord compression and myelopathy, leading to major morbidity and mortality. Intervention is often required. Does the presence of widened bullet shaped vertebra in platyspondily encroach on the spinal canal and cause spinal stenosis in MPS IVA? So far, there have been no standardised morphometric measurements of the paediatric MPS IVA cervical spine to evaluate whether there is pre-existing spinal stenosis predisposing to compressive myelopathy or whether this is purely an acquired process secondary to instability and compression. This study provides the first radiological quantitative analysis of the cervical spine and spinal cord in a series of affected children. MRI morphometry indicates that the MPS IVA spine is narrower at C1–2 level giving an inverted funnel shape. There is no evidence of a reduction in the Torg ratio (canal-body ratio) in the cervical spine. The spinal canal does not exceed 11 mm at any level, significantly smaller than normal historical cohorts (14 mm). The sagittal diameter and axial surface area of both spinal canal and cord are reduced. C1–2 level cord compression was evident in the canal-cord ratio but the Torg ratio was not predictive of cord compression. In MPS IVA the reduction in the space available for the cord (SAC) is multifactorial rather than due to congenital spinal stenosis.     

Early results of full-endoscopic decompression of lumbar central canal stenosis by outside-in technique: A clinical and radiographic study

Retrospective cohort study.Full-endoscopic decompression of lumbar spinal canal stenosis is being performed by endoscopic surgeons as an alternative to micro-lumbar decompression in the recent years. The outcomes of the procedure are reported by few authors only. The aim of this paper is to report the clinical and radiographic outcomes of full endoscopic lumbar decompression of central canal stenosis by outside-in technique at 1-year follow-up.We reviewed patients operated for lumbar central canal stenosis by full endoscopic decompression from May 2018 to November 2018. We analyzed the visual analogue scale scores for back and leg pain and Oswestry disability index at pre-op, post-op, and 1-year follow-up. At the same periods, we also evaluated disc height, segmental lordosis, whole lumbar lordosis on standing X-rays and canal cross sectional area at the affected level and at the adjacent levels on magnetic resonance imaging and the facet length and facet cross-sectional area on computed tomography scans. The degree of stenosis was judged by Schizas grading and the outcome at final follow-up was evaluated by MacNab criteria.We analyzed 32 patients with 43 levels (M:F = 14:18) with an average age of 63 (±11) years. The visual analogue scale back and leg improved from 5.4 (±1.3) and 7.8 (±2.3) to 1.6 (±0.5) and 1.4 (±1.2), respectively, and Oswestry disability index improved from 58.9 (±11.2) to 28 (±5.4) at 1-year follow-up. The average operative time per level was 50 (±16.2) minutes. The canal cross sectional area, on magnetic resonance imaging, improved from 85.78 mm² (±28.45) to 150.5 mm² (±38.66). The lumbar lordosis and segmental lordosis also improved significantly. The disc height was maintained in the postoperative period. All the radiographic improvements were maintained at 1-year follow-up. The MacNab criteria was excellent in 18 (56%), good in 11 (34%), and fair in 3 (9%) patients. None of the patients required conversion to open surgery or a revision surgery at follow-up. There was 1 patient with dural tear that was sealed with fibrin sealant patch endoscopically. There were 10 patients who had grade I stable listhesis preoperatively that did not progress at follow-up. No other complications like infection, hematoma formations etc. were observed in any patient.Full endoscopic outside-in decompression method is a safe and effective option for lumbar central canal stenosis with advantages of minimal invasive technique.     

Clinical and radiological features of atlantoaxial joints in rheumatoid arthritis

Summary Atlantoaxial (AA) instability is frequent radiological finding in patients with rheumatoid arthritis (RA). Mostly no serious neurological disorders are expected in such patients. The purpose of the study was to assess the sagittal spinal canal diameter according to Steel’s rule of third and its relationship to clinical symptoms. Radiological and clinical evaluation was performed in 65 in-patients with RA. Fifty four patients complained of neck pain, 39 had vertebrobasilar symptoms, and 25 mild neurological disorders. A hyperreflexy tendon responses were registered in 16 patients. Only 1 patient had extensor plantar response. Forward AA dislocation was verified in 28 (43%) cases with a mean value of 8.3mm (4–17mm). Still free space for spinal cord in spinal canal was obtained in 62 (95%) of patients, which can explain such a low incidence of serious neurological disorders. Our results suggest an association among duration of disease, atlantodental distance, and sagittal spinal canal diameter. We consider that it is important to detect early the most jeopardized patients on the basis of radiological analysis at C1 level according to Steel’s rule of third and recognize when „safe zone” has exceeded and enters the area of impending spinal cord compression. Received: 12 January 1998 Accepted: 20 May 1999     

The effect of oestradiol implants on regional and total bone mass: a three-year longitudinal study

OBJECTIVE Although there is evidence from cross-sectional studies that percutaneous oestrogen administration protects against menopausal bone loss, few longitudinal data are available. We have examined the effect of 3 years' treatment with percutaneous oestradiol on total body calcium, spinal trabecular bone mineral density and radial bone mineral content in post-menopausal women. DESIGN and PATIENTS Twenty-nine post-menopausal women, aged 37–55 years, who had undergone hysterectomy and had experienced the onset of menopausal symptoms within the previous 2 years, were studied before and for 3 years during hormone replacement with oestradiol implants, given at approximately 6-monthly intervals. MEASUREMENTS Total body calcium was measured by prompt gamma neutron activation analysis, spinal trabecular bone mineral density by quantitative computed tomography and radial bone mineral content by single-photon absorptiometry. RESULTS There was a significant increase in the mean total body calcium, spinal trabecular bone mineral density and radial bone mineral content over the 3 years of the study. The mean (± SEM) percentage change per annum was +2 4% (±0.8) for total body calcium (P <0 01), + 3.3% (±0.6) for spinal trabecular bone mineral density (P < 0.001) and +12% (± 0.6) for radial bone mineral content (P < 0 05). CONCLUSIONS Percutaneous oestradiol replacement therapy prevents menopausal bone loss and is associated with a sustained and significant increase in total body calcium, spinal trabecular bone mineral density and radial bone mineral content over a 3-year treatment period. Oestradiol implants thus have skeletal effects comparable to those of oral or transdermal oestrogens.     

THE DIAGNOSTIC VALIDITY OF LOCAL AND TOTAL BONE MINERAL MEASUREMENTS IN POSTMENOPAUSAL OSTEOPOROSIS AND OSTEOARTHRITIS

Assessment of different forms of prevention and treatment of bone mineral loss depends upon valid and precise methods to assess bone mass. We have here studied four groups of women: 45 healthy premenopausal women, 37 healthy postmenopausal women, 21 women with osteoarthritis and 20 with hip fractures. Bone mass was measured in the spine and total body by dual photon absorptiometry and in two forearm sites (proximal and distal bone mineral content (BMC) by single photon absorptiometry. The long-term (1 year) reproducibility was 1.2% for proximal BMC, 1.6% for distal BMC, 5.5% for spinal BMC, and 2.1% for total body bone mass (TBBM). In the early postmenopausal years bone mass was mainly reduced in areas with a high content of trabecular bone. In elderly postmenopausal women and women with hip fractures bone mass was almost identical in all four sites studied. The osteoarthritic patients had an 18% reduction of bone mass in the forearms and in TBBM, whereas the spinal bone mass was only reduced by 6%. In all subgroups TBBM could be predicted from the forearm measurements with standard errors of estimates of 9-13%. When the osteoarthritic women were excluded spinal bone mass could be predicted from both forearm measurements with a standard error of 15% (r = 0.74). The distal forearm BMC seems to be a more accurate estimate of spinal bone mass than does the proximal measurement. Of the 20 patients with hip fracture 16 had a distal forearm value below the premenopausal normal range, whereas spinal bone mass was subnormal in only eight (P less than 0.05). We conclude that bone loss is universal in patients with hip fracture and measurements of forearm bone mass will meet most clinical and research demands.     

Percutaneous vertebroplasty for elderly patients with unhealed osteoporotic spinal fractures

Background:   Vertebroplasty is a procedure in which bone cement is injected percutaneously into the vertebral body.
Methods:   We used this technique with 15 patients who had pseudarthrosis or delayed union of osteoporotic spinal fractures with vacuum clefts, and in whom conservative treatment did not relieve persistent pain. The procedure was performed in a short time with little blood loss, and no generic complications, leakage of bone cement to blood vessels or the spinal canal, or neural compression.
Results:   At 1 week after the operation, pain was eliminated in seven patients, alleviated in seven patients, unchanged in one patient, and worsened in none. The rate of alleviation or elimination of pain after 1 week and 6 months was 93% and 85%, respectively. Recurrence of the pain was seen in four cases, but this was caused by new spinal fractures in separate locations, confirmed with magnetic resonance imaging, in three patients, and by multiple myeloma in one patient.
Conclusion:   Thus, vertebroplasty, which alleviates pain rapidly and with low invasiveness, is a new and promising therapy for osteoporotic spinal fractures in which conservative treatment has failed. It seems to provide a large benefit to elderly patients if performed with prudent care with regard to complications at the time of bone cement injection, and in conjunction with treatment for osteoporosis.     

Lumbar bone mineral density at final height and prevalence of fractures in treated children with GH deficiency

Lumbar bone mineral density (BMD) by dual energy x-ray absorptiometry was assessed in 46 (29 boys, 17 girls) treated patients with growth hormone deficiency (GHD) at final height, comparing the BMD results with normative data. Prevalence of fractures in patients during treatment and healthy controls (n = 100) during the corresponding time period was assessed. Lumbar BMD values at final height of fractured and fracture-free patients were compared between them. Lumbar BMD corrected for bone area was significantly (P < 0.01) reduced (boys, -0.4 +/- 0.8 Z score; girls, -0.5 +/- 0.7 Z score), but lumbar BMD corrected for bone size (BMDvolume) did not differ [P = not significant (NS); boys -0.2 +/- 1.0 Z score; girls, -0.3 +/- 1.0 Z score] from normal mean. Approximately 22% of patients had reduced lumbar BMD (Z score, -1 to -2). The fact that patients had a complete or partial GHD did not influence lumbar BMD. The prevalence of fractured patients did not differ (P = NS) from that of controls [n = 7 (15.2%) and n = 24 (24.0%), respectively; odds ratio, 1.837]. Lumbar BMDvolume of fractured patients was significantly (P < 0.02) lower than that of fracture-free (n = 39) patients (boys, 0.310 +/- 0.005 and 0.351 +/- 0.032 g/cm(3), respectively; girls, 0.326 +/- 0.027 and 0.382 +/- 0.036 g/cm(3), respectively). The percentage of the fractured patients with lumbar BMDvolume less than 1 SD of normal mean was significantly (P < 0.0001) higher than that of fracture-free patients [n = 6 (85.7%) and n = 4 (10.3%), respectively; odds ratio, 26.092). The fractured patients also showed reduced lumbar BMD corrected for bone area and BMDvolume at the time of fractures (-1.6 +/- 0.4 and -1.5 +/- 0.2 Z score, respectively). The results show that treated patients with GHD have normal mean values of lumbar BMDvolume at final height, but some patients have reduced lumbar BMD (Z score <1) with an increased susceptibility to fractures.