动脉阻断致颈髓急性缺血性损伤的实验研究

[目的]研究颈髓脊髓前动脉、前根动脉阻断对颈髓缺血性损伤的影响。[方法]将48只家兔随机分为阻断脊髓前动脉组和间接阻断前根动脉组（阻断脊髓前动脉＋双侧椎动脉），两组均设有对照组。每组各在术后6、24、72h检测颈髓血流灌注量，运动诱发电位、组织能量代谢变化，电镜观察细胞形态学改变。[结果]脊髓前动脉阻断后颈髓前部表面血流量下降了50．28％，随后有所回升；运动诱发电位潜伏期延长；ATP和EC进行性下降，出现急性缺血性改变；间接阻断前根动脉组其各指标变化更加明显，同阻断脊髓前动脉相比，存在显著差异，P〈0．05。[结论]脊髓前动脉对颈髓前部血流起着重要的作用，阻断后造成脊髓缺血性损伤，但有部分代偿；前根动脉对颈髓血供有重要的补充和支持作用，临床上各种原因造成的根动脉损伤势必对颈髓带来损害。     

急性脊髓前动脉阻断致颈髓缺血损伤的实验研究

目的观察急性脊髓前动脉阻断后颈髓血流量的变化、组织能量代谢和病理学改变,研究病理机制。方法以家兔为试验模型,阻断C2段脊髓前动脉,在术后6h、24h和72h采用激光多普勒血流测定仪测定颈髓血流灌注量,检测组织能量代谢变化,电镜观察细胞形态学改变。结果术后各时相点血流量下降明显,能量代谢进行性下降,出现急性缺血性改变。结论脊髓前动脉阻断后随着血流量和能量代谢的下降,颈髓组织发生渐进性破坏,但颈髓血供出现部分代偿。     

双侧椎动脉结扎致颈髓缺血性损伤的实验研究

目的：研究双侧椎动脉血流阻断对颈髓的影响。方法：结扎兔双侧椎动脉颈段，在术后4h、8h、24h、28d采用激光多普勒血流测定仪测定颈髓血流灌注量，并观察兔颈髓组织细胞形态学及相关免疫组化的变化。结果：术后4h、8h、24h组颈髓血流灌注量明显下降，术后28d组无明显改变；术后8h、24h组颈髓呈急性缺血性改变，而4h、28d组未见明显异常。结论：双侧椎动脉血流阻断可引起兔颈髓相应区域急性缺血损伤．但其后期代偿路径、代偿机制有待进一步研究。     

颈髓血流障碍与脊髓型颈椎病发病机制的实验研究

目的观察脊髓前动脉阻断对颈髓血供、功能的影响及其病理学变化,研究脊髓型颈椎病的发病机制。方法以家兔为实验模型,阻断C2段脊髓前动脉,在术后6h、24h、72h采用改良Tarlov法对动物行为学评级以及检测运动诱发电位的变化,应用激光多普勒血流测定仪测定颈髓血流灌注量,并观察兔颈髓组织细胞形态学、相关免疫组化的变化。结果术后各时相点神经功能减退,血流量下降明显,神经元骨架结构紊乱,细胞器破坏,出现急性缺血性改变。结论脊髓前动脉血流障碍可导致颈髓缺血性病变,引起脊髓的梗死,是脊髓型颈椎病发生不可忽视的重要因素,对其治疗应注意改善局部血液循环。     

双侧椎动脉颈段完全栓塞早期对兔颈髓血流的影响

目的 :研究椎动脉颈段栓塞对颈髓血流量的影响。方法 :结扎兔双侧C6、C7处椎动脉 ,在术后 4、 8、2 4h观察行为学、细胞形态学 ,并采用激光多普勒血流测定仪测定颈髓血流。结果 :术后 4、 8、 2 4h组颈髓血流量明显下降 ,8、 2 4h组呈急性缺血性改变。结论 :椎动脉供血区血流量减少可导致颈髓相应区域急性缺血损伤。     

脊髓前动脉损伤后脊髓病理演变的实验研究

目的：观察脊髓前动脉损伤后脊髓组织形态学演变过程，研究病理机制。方法：以家犬为实验模型，损伤脊髓前动脉后进行肉眼、光镜和电镜动态观察，定量测定坏死神经元。结果：脊髓前动脉损伤2h运动神经元变性，轴索病变，6h神经元坏死，24h脊髓水肿达到高峰，7d髓内出血最明显。在脊髓前动脉损伤节段，24h 30％一40％的运动神经元坏死，3d达80％，7d以后95％以上。病变均位于脊髓2／3。脊髓前动脉损伤节段变性坏死最严重，相邻节段其次，尾侧脊髓坏死量逐渐减少。结论：脊髓前动脉损伤后脊髓缺血性病变是渐进和不可逆的，可引起广泛节段脊髓病变。     

兔颈髓牵张性损伤早期脊髓血流变化的特点及意义

目的 观察兔颈髓不同程度牵张性损伤早期脊髓血流的动态变化，探讨其特点和意义。方法 构建颈髓牵张性损伤模型，应用激光多普勒血流仪按不同时相点检测颈5、6段脊髓血流变化，同时取相同节段颈髓行组织病理检查。结果 对照组A脊髓血流量平均基线值和B组、C组、D组牵张前无统计学差异。随着牵张距离的不断增加，颈髓血流量呈进行性下降。当颈髓牵张损伤程度超过脊髓微血管自我调节能力时，则脊髓血流不能恢复。各组颈髓组织病理学检查结果与相应的颈髓血流量变化趋势一致。结论 脊髓血流量的降低是颈髓牵张性损伤继发神经功能障碍的基础，与颈髓的牵张程度呈正相关。     

肢体缺血预处理对兔颈髓慢性缺血后再灌注损伤的影响

目的：探讨肢体缺血预处理对兔颈髓慢性缺血后再灌注损伤的影响及其机制。方法：建立兔颈髓慢性压迫损伤模型，随机分为实验组和对照组。实验组在脊髓减压再灌注前给予肢体缺血预处理，对照组不做预处理。两组兔在减压前和减压后2h、8h、24h，7d、21d分别进行后肢神经功能评分。在减压后即刻、0．5h、1h和以上时间点分别进行脊髓血流测定。处死动物取脊髓(C1～T1)进行组织病理学检查。结果：实验组于再灌注8h后神经功能评分明显好于对照组。实验组脊髓组织丙二醛含量于再灌注8h后显著低于对照组。两组再灌注后脊髓血流均显著下降，实验组优于对照组。病理学检查示对照组神经元呈缺血改变，白质水肿、脱髓鞘；实验组病理改变轻微。实验组热休克蛋白70表达阳性，对照组为阴性。结论：肢体缺血预处理对脊髓慢性缺血后的再灌注损伤具有明显保护作用。     

脊髓缺血性损伤的MRI与病理演变对照实验研究

目的：研究脊髓缺血性损伤的MRI变化规律及其特征,及相应的病理机制。方法：以家犬为实验模型,采用颈前路手术入路,损伤颈脊髓前动脉,进行肉眼、光镜观察。同时观察MRI异常信号演变过程和特征性表现。结果：脊髓前动脉损伤后出现脊髓水肿、出血,运动神经元变性坏死等病理性变化。MRI异常信号出现在脊髓前动脉损伤节段的前2／3,多表现为一侧受累及或偏向一侧。结论：脊髓缺血性损伤后的脊髓出血、水肿在MRI得到不同程度的反映。MRI能确定脊髓缺血性损伤的部位。     

恒河猴脑选择性超深低温断血流复苏模型的建立

目的探讨猴脑选择性超深低温断血流复苏的可行性。方法4至10岁健康恒河猴10只,动物随机分为3组：4血管(双侧颈总动脉及椎动脉)阻断冷灌注组4只,2血管(双侧颈总动脉)阻断冷灌注组4只,等温灌注组2只。手术前后行头颅MRI检查,手术中监测生命体征及血流动力学指标变化,术后行神经功能缺失评分。结果在10只实验猴中,2血管阻断冷灌注组4只恒河猴术中、术后血流动力学稳定,灌注60min后安全复苏并长期存活,术后头颅MRI检查未见异常,术后神经功能评分无异常;等温灌注组2只恒河猴及4血管阻断冷灌注组4只恒河猴于灌注60min后均未能安全复苏,全部死亡。结论阻断双侧颈总动脉行猴脑选择性超深低温60min后可安全复苏。     

CT angiography of anterior spinal artery in cervical spondylotic myelopathy

Purpose

To identify anterior spinal artery (ASA) infarct or occlusion by CT angiography (CTA) in patients with cervical spondylotic myelopathy (CSM).

Methods

Fourteen patients with CSM were performed CTA of ASA after admission. T2-weighted hyperintensity of MR image was compared with image of CTA of ASA.

Results

All patients presented spinal canal sagittal diameter compression from 10 to 80 % and different T2-weighted hyperintensity of MR images. No ASA infarct or occlusion was found in CSM patients.

Conclusion

ASA infarct or occlusion is not commonly seen in CSM patients with spinal canal sagittal diameter compression less than 80 %. Pathological changes about T2-weighted hyperintensity of MR image in CSM have no close correlation with ASA infarct.     

能谱CT脊髓前动脉造影在颈髓损伤患者中应用价值的初步探讨

目的:探讨能谱CT脊髓前动脉造影在颈髓损伤患者中的应用价值,评价脊髓前动脉血流量改变与术后神经功能恢复的相关性。方法:2014年1月至2016年6月对30例颈髓损伤患者行颈后路单开门椎管成形术治疗,其中男21例,女9例;年龄33~59(46.4±9.7)岁;均在伤后2周内接受颈后路单开门椎管成形术,其中开门减压3节段8例,4节段18例,5节段4例。术前3 d内及术后5 d进行能谱CT检查,重建脊髓前动脉并评估其术后血流量改善情况;术前1 d,术后5 d及1、6、12个月对患者进行颈椎JOA评分,并计算相应随访点术后JOA评分改善率。结果:所有患者获得随访,时间12~30(17.4±7.6)个月。术前术后脊髓前动脉碘含量比值(ASA/VA)分别为0.75±0.20、0.89±0.02,术后较术前有显著改善(P0.01),术后平均ASA/VA改善率为(21.05±12.45)%,且血流改善程度与术后1、6、12个月JOA评分改善程度之间存在线性正相关。结论 :能谱CT脊髓前动脉造影安全可行,成像满意,可定量评价脊髓前动脉血流量的改善程度;脊髓前动脉血流改善程度与神经功能恢复程度之间存在线性正相关,术后早期的脊髓前动脉血流改善程度或可作为预判患者神经功能恢复的参考指标之一。     

Spinal cord infarction caused by cartilage embolus to the anterior spinal artery

Cartilaginous embolization of spinal vessels is a rare cause of spinal cord infarction. A 63-year-old woman developed sudden onset of painful, fatal paraparesis following a valsalva-like maneuver. Autopsy demonstrated recent nonhemorrhagic infarction of the caudal thoracic spinal cord secondary to complete occlusion of the anterior spinal artery by cartilage. The literature pertaining to 28 previously reported cases is briefly reviewed.     

颈椎病致脊髓前动脉综合征

目的 报告一组因颈椎病引起的脊髓前动脉综合征,分析其临床表现,并探讨其机制和影像学表现特点和治疗.方法 共25例,男16例,女9例;平均年龄53.2岁.在典型的脊髓型颈椎病基础上无外伤等明显诱因,短期内症状急剧加重19例,逐渐加重6例.除脊髓型颈椎病的体征外,均出现浅感觉丧失或减退,而深感觉存在的"感觉分离"现象.下肢痉挛性瘫痪.其中12例伴有不同程度的肛门、膀胱功能失控.X线片和CT显示颈椎不同程度的退变.其中伴有颈椎管狭窄10例、颈椎不稳12例、颈椎后纵韧带骨化6例.MR检查发现均为椎间盘中央型突出,脊髓前中央受压迫.脊髓多有不同程度地萎缩.大部分病例在脊髓前2/3 T1WI信号稍低或无明显变化,T2WI高信号或稍高信号,但有6例T1WI和T2WI信号均无改变.在缓慢起病的患者中,有3例脊髓前2/3囊性变.前路减雎24例,后路减压1例,采用JOA评分评估疗效.结果 平均随访16个月,术后疗效优(脊髓功能恢复率≥75%)11例,良(50%～74%)7例,一般(25%～49%)6例,差(≤24%)1例.结论 在无明显诱因下颈椎病椎间盘中央型突出可引起脊髓前动脉综合征."感觉分离"是诊断此疾病的基础,同时结合病史、临床症状和其他体征以及影像学检查给予确诊.及时减压可取得较佳的疗效.     

Critical ischemia time in a model of spinal cord section. A study performed on dogs

Vascular changes after acute spinal cord trauma are important factors that predispose quadriplegia, in most cases irreversible. Repair of the spinal blood flow helps the spinal cord recovery. The average time to arrive and perform surgery is 3 h in most cases. It is important to determine the critical ischemia time in order to offer better functional prognosis. A spinal cord section and vascular clamping of the spinal anterior artery at C5–C6 model was used to determine critical ischemia time. The objective was to establish a critical ischemia time in a model of acute spinal cord section. Four groups of dogs were used, anterior approach and vascular clamp of spinal anterior artery with 1, 2, 3, and 4 h of ischemia and posterior hemisection of spinal cord at C5–C6 was performed. Clinical evaluation was made during 12 weeks and morphological evaluation at the end of this period. We obtained a maximal neurological coordination at 23 days average. Two cases showed sequels of right upper limb paresis at 1 and 3 ischemia hours. There was nerve conduction delay of 56% at 3 h of ischemia. Morphological examination showed 25% of damaged area. The VIII and IX Rexed’s laminae were the most affected. The critical ischemia time was 3 h. Dogs with 4 h did not exhibit any recovery.     

Anterior Spinal Artery Syndrome in a Patient with Cervical Spondylosis Demonstrated by CT Angiography

A few published reports have described anterior spinal artery syndrome (ASAS) with cervical spondylosis based on clinical presentation and/or MRI study, but no photographs of anterior spinal arteries were provided in these studies. Here we present a case of ASAS with cervical spondylosis in a CT angiography (CTA) study. A previously healthy 31‐year‐old man was diagnosed with acute ASAS with cervical spondylosis. Neurological examination revealed four‐limb weakness predominant in the distal part of the upper limbs and superficial sensory impairment below the cervical region. T2‐weighted images on MRI showed an area of hyperintensity in the gray matter of the cervical cord from C₃ to C₅ with a disc herniation at the C_4,5 vertebral level. CTA demonstrated that ASA was occluded at level C_4,5, which coincided with the location of disc herniation. Anterior spinal cord decompression and fusions were performed. The patient tolerated the procedure well and had complete resolution of his exertionally dependent myelopathic symptoms 1 week later. In conclusion, although ASAS with cervical spondylosis is rare, it can be diagnosed based on clinical symptoms and MRI and identified by CTA of ASA. A good neurological prognosis is anticipated after anterior spinal cord decompression and fusion is performed if disc herniation is responsible for ASA occlusion.     

胸腰椎结核伴截瘫的前路手术治疗

[目的]探讨胸腰椎脊柱结核伴截瘫的手术治疗方法和疗效。[方法]总结30例胸腰椎结核伴截瘫患者,采用前路病灶清除、椎管减压、椎间植骨并前路固定的手术治疗,术后抗结核治疗18个月。[结果]全部病例随访平均19个月,30例结核全部治愈,其中有2例复发,植骨融合29例,后凸矫正角度12°,神经功能恢复优良率90%。[结论]经前路病灶清除、椎管减压、椎间植骨前路内固定术治疗胸腰椎脊柱结核伴截瘫,能获得较好效果。     

Chylous injury following anterior spinal surgery: Case reports

Chylous leakage is an unusual complication following anterior spinal surgery. This leakage can occur as a result of traumatic injury to the thoracic duct, the cisterna chyli, or the retroperitoneal lymphatic vessels. The authors present case reports of three patients who underwent anterior spinal surgical procedures in advertently complicated by an injury to the lymphatic system. All patients were managed nonoperatively with tube drainage and hyperalimentation and had uneventful recoveries.     

Drill burrs for anterior decompression of the spinal cord--a new device

We have devised a new drill burr that is particularly suitable for an anterior approach to the spinal cord. The drill burr is conical in shape, with a shaft attached to its top and fine diamond edges on the curved slope, but not on its tip. The bone is scraped off while the burr is being gently pulled up but not pressed down. This new drill burr has proved to be most useful in safely removing osteophytes and hypertrophied uncovertebral joints without damaging the already compromised spinal cord.     

胸腰椎结核前路手术的并发症及其防治

目的:探讨胸腰椎结核前路手术的并发症及其防治措施。方法:2000年2月-2006年12月我院采用一期前路病灶清除植骨内固定术治疗胸腰椎结核患者79例,其中男36例,女43例,年龄12-78岁,平均39.8岁。T4-T1028例,T11-L132例,L2-L419例。统计并发症发生的例数,分析其发生原因。结果:随访5-40个月,平均18.2个月。共12例(15.2%)发生并发症,术中并发症5例,其中淋巴管漏1例,肋间神经损伤4例;术后并发症7例,其中深静脉血栓形成1例,肺不张2例,结核复发2例,螺钉切割椎体进入椎间隙2例。原因多与术中操作不仔细或适应证掌握不当有关。结论:为降低脊柱结核前路手术的并发症,应严格掌握手术适应证,应熟悉解剖,术中仔细操作,提高手术技巧,彻底清除病灶,做好各项围手术期的处理。