后路椎弓根固定加椎间植骨治疗胸腰椎爆裂骨折

目的 探讨后路椎弓根螺钉同定联合椎间植骨治疗胸腰椎爆裂骨折的疗效. 方法对62例胸腰椎爆裂骨折患者采用后路减压国产通用型脊柱固定系统(general spine system, GSS)椎弓根螺钉固定联合椎间植骨融合手术,比较术前、术后相邻椎体上下终板成角(Cobb角)、椎体前缘高度与正常高度的比值、椎管骨性占位率等指标,了解术后骨折复位情况以及随访期间内固定有无失败和复位丢,大情况. 结果通过手术减压复位,Cobb角、椎体前缘高度与正常高度的比值、椎管骨性占位率均明显改善.术后随访测量与术后相比无明显变化,无一例发生内固定失败. 结论后路椎弓根螺钉联合椎间植骨治疗胸腰椎爆裂骨折可以有效防止内固定失败、复位丢失和后凸畸形,是治疗胸腰椎爆裂骨折较理想的方法.     

跨伤椎与经伤椎短节段内固定术在治疗胸腰椎椎体骨折的临床观察

目的探讨跨伤椎与经伤椎短节段内固定在胸腰椎椎体骨折的临床疗效。方法收集亳州市人民医院骨科2015年1月～2016年7月收治的50例经短节段内固定治疗的胸腰椎椎体骨折患者进行回顾性分析,采用跨伤椎短节段内固定手术的22例(对照组)和采用经伤椎短节段内固定手术的28例(实验组),比较两组患者术前、术后、术后6个月的椎体前缘高度比、矢状面Cobb角的变化及手术时间、术中出血量。结果 (1)在椎体前缘高度比、矢状面Cobb角的对照中,术前两组间比较差别无统计学意义(P0.05),术后与术前比较差异有统计学意义(P0.05);术后两组间对照中,实验组的椎体前缘高度比(88.8±10.5)%大于对照组(85.1±10.1)%、矢状面Cobb角(5.7±3.2)°小于对照组(6.3±4.7)°,差异有统计学意义(P0.05);术后6个月两组间对照中,实验组的椎体前缘高度比(86.0±10.4)%大于对照组(80.6±10.4)%、矢状面Cobb角(6.8±3.6)°小于对照组(12.1±5.6)°,差异均有统计学意义(P0.05)。(2)手术时间、出血量实验组分别为(125±20.5)min和(252.6±48.4)m L,均大于对照组(100±26.4)min和(146.4±50.2)m L,差异有统计学意义(P0.05)。结论经伤椎短节段内固定在胸腰椎椎体骨折的后凸畸形矫正、骨折椎体高度重建、术后恢复上优于跨伤椎短节段内固定,手术时间长,出血多。     

胸腰段脊柱骨折不同固定方式疗效对比分析

目的 对比跨伤椎固定与经伤椎固定治疗胸腰段脊柱骨折的疗效. 方法 回顾性分析2005年6月-2008年12月分别采用跨伤椎固定与经伤椎固定治疗的56例胸腰段脊柱骨折,其中男41例,女15例;年龄21 ～ 66岁,平均41.5岁.损伤部位:T1213例,L127例,L2 16例.按AO分型:A1.2型6例,A3.1型29例,A3.2型9例,A3.3型12例.载荷评分5～8分,平均6.3分.脊髓神经损伤按Frankel分级:A级3例,B级4例,C级8例,D级17例,E级24例.采用椎弓根螺钉跨伤椎固定27例,经伤椎固定29例,两组患者均选择性进行单节段植骨融合.对比两组患者术前、术后和最后随访时的Cobb角、伤椎前缘高度恢复及椎管占位情况的变化.随访过程中观察植骨融合和脊髓神经恢复情况.采用Denis评分比较两组患者局部疼痛和工作状态的恢复差异. 结果 所有患者获随访12 ～48个月,平均25.8个月.跨伤椎固定组1例于术后1.5个月出现棒松动,其余未出现内固定松动或断裂现象.在术后Cobb角矫正、椎体前缘高度恢复、椎管占位率恢复及最后随访时椎体前缘高度和椎管占位保持方面两组间差异无统计学意义(P＞0.05).术后两组患者矫正度均存在丢失现象,跨伤椎固定组最后随访时的Cobb角与术后比较差异有统计学意义(P＜0.05),经伤椎固定组最后随访时的Cobb角与术后比较差异无统计学意义(P＞0.05),两组间Cobb角矫正度丢失率差异有统计学意义(P＜0.05).跨伤椎固定组植骨融合21例(78％),经伤椎固定组植骨融合27例(93％)(P＜0.05).在局部疼痛评分上,经伤椎固定组优于跨伤椎固定组(P＜0.05),而在工作状态的恢复方面两组差异无统计学意义(P＞0.05).结论 相对跨伤椎固定,经伤椎固定治疗胸腰椎骨折能够获得较高的植骨融合率,同时能更好地维持脊柱矫正度,是胸腰椎骨折后路治疗的较好选择.     

经伤椎与不经伤椎椎弓根螺钉复位固定治疗胸腰椎骨折的临床对比研究

目的 比较经伤椎与不经伤椎椎弓根螺钉复位固定治疗胸腰椎骨折的临床效果.方法 回顾性研究2006年3月-2008年2月收治的胸腰椎单一椎体骨折患者27例,其中12例采用骨折椎加用椎弓根螺钉固定(A组),15例采用传统双平面固定(B组).A组男9例,女3例,平均年龄43岁(25～56岁);B组男10例,女5例,平均年龄42岁(23～61岁).所有患者均为新鲜骨折并且骨折椎一侧或双侧椎弓根完整.所有患者均于麻醉状态下行体位复位,B组行后路常规伤椎上下椎体椎弓根螺钉置入复位固定;A组在B组方法 基础上加用伤椎椎弓根螺钉置入复位固定.观测患者后凸畸形(Cobb角)及伤椎高度恢复情况. 结果 术后随访5～22个月,平均9个月.经伤椎椎弓根螺钉使骨折椎向腹侧移动复位,术后Cobb角及前柱高度恢复较佳.手术前后骨折椎前移复位程度的变化:A组为0.089±0.036,B组为0.023±0.048(P<0.001);两组Cobb角的变化:A组为(9.88±7.69)°,B组为(5.19±3.24)°(P<0.05);伤椎前柱高度的变化:A组为(39.3±5.2)%,B组为(20.6±6.5)%(P<0.05).骨折椎加用椎弓根螺钉在前柱撑开的同时可有效控制正常椎间盘高度的撑开. 结论对胸腰椎单一椎体骨折有条件地应用伤椎椎弓根螺钉有利于矫正后凸畸形和恢复伤椎前缘高度,并且增强胸腰椎骨折后路短节段内固定系统的牢固性和维持矫正效果.     

单节段复位固定治疗创伤性胸腰椎骨折

目的 评价单节段椎弓根螺钉复位固定胸腰椎爆裂性骨折的临床疗效. 方法 自2003年10月至2008年2月,采用单节段椎弓根螺钉固定治疗A3.1型(37例)、A3.2型(30例)胸腰椎骨折.术后摄X线片来测量骨折椎楔变指数、骨折节段矢状位指数评价影像学效果,并通过腰功能评分评价临床疗效. 结果 所有患者手术顺利,手术用时平均93 min,术中出血量平均157 ml.随访65例,平均随访时间为19.8个月(4～27个月),全部骨性融合,除1例出现螺钉松动外,无内固定失败.术前骨折节段平均矢状位指数及骨折椎楔变指数分别为13.06°、42.96%,术后分别为4.47°、21.78%,均较术前明显改善(P<0.01).除2例外,最后随访末见明显矫正丢失(P<0.05).临床腰功能评分较术前明显改善(P<0.05). 结论 经骨折椎单节段复位固定融合术具有创伤小、用时短、出血少、脊椎运动功能单位丢失减少等优点,可用于治疗部分胸腰椎爆裂型骨折.     

经椎弓根椎体支柱块置入治疗胸腰椎骨折的短期疗效观察

目的 研究经椎弓根置入椎体支柱块并植骨治疗胸腰椎骨折的方法和疗效. 方法收集2008年3月-2009年7月采用经椎弓根椎体支柱块并植骨治疗胸腰椎骨折患者共23例(25个椎体,共用47枚椎体支柱块),T11骨折2例,T12骨折9例,L1骨折7例,L2骨折5例,其中4例采用椎板间开窗减压椎弓根固定联合椎体支柱块治疗.观察手术操作过程、手术用时、术中出血量、术后及随访期间摄X线片,测定伤椎前缘高度与正常高度的比值、Cobb角的矫正程度及术后早期恢复情况. 结果 23例患者均获7～16个月[(12.5±0.4)个月]随访,术后椎体高度丢失少,术后伤椎前缘压缩率及Cobb角均较术前明显改善(P＜0.05). 结论椎体支柱块治疗胸腰椎骨折可有效恢复椎体力学性能,减少椎体高度再丢失、后凸畸形重现等并发症,具有手术时间短、出血少、恢复快、更符合生物学固定等优点,是治疗胸腰椎骨折较理想的方法.     

经椎弓根内侧入路减压复位治疗胸腰段椎体爆裂骨折76例临床疗效分析

目的探讨经椎弓根内侧入路减压复位在治疗胸腰段椎体爆裂骨折合并脊髓神经损伤中的临床疗效。方法回顾性分析2012年8月—2018年12月陆军军医大学大坪医院脊柱外科收治的胸腰段椎体爆裂骨折合并脊髓神经损伤患者76例,男性47例,女性29例;年龄17～61岁,平均35.6岁。骨折AO分型:A1.3型43例,A2.1型19例,A2.2型7例,A3.1型5例,A3.2型2例。按脊髓损伤程度分为完全性脊髓损伤组5例、不完全性脊髓损伤组71例;根据美国脊髓损伤学会(ASIA)感觉评分和运动评分进行评估,所有患者行后路切开经椎弓根内侧入路减压复位、椎弓根钉棒系统内固定及后外侧植骨融合治疗,均于术前、术后末次随访12个月摄脊柱正侧位X线片和CT片,通过术前、末次随访伤椎椎体前缘高度恢复率、Cobb角、椎管侵占率、ASIA评分4个主要指标评估临床疗效。结果所有患者随访12个月,未发生内固定物断裂及椎体前缘高度丢失等并发症;椎体前缘高度恢复率:术前(47.3%±9.8%),术后12个月(87.1%±4.7%),差异有统计学意义(P0.05);Cobb角:术前(29.3°±5.8°),术后12个月(6.3°±2.8°),差异有统计学意义(P0.05);椎管侵占率:术前(29.5%±6.7%),术后12个月(11.3%±5.8%),差异有统计学意义(P0.05);完全性脊髓损伤组感觉评分:术前(150±17)分,术后12个月(175±16)分;运动评分:术前(47±14)分,术后12个月(79±11)分,差异均有统计学意义(P0.05);不完全性脊髓损伤组感觉评分:术前(167±21)分,术后12个月(186±13)分;运动评分:术前(71±15)分,术后12个月(82±14)分,差异均有统计学意义(P0.05)。结论经椎弓根内侧入路减压复位、椎弓根钉棒系统内固定治疗胸腰段椎体爆裂骨折能有效减压、恢复椎体高度、促进脊髓神经功能恢复,临床疗效良好。     

伤椎固定结合硫酸钙椎体成形与单纯伤椎固定治疗胸腰椎爆裂骨折的对比研究

目的 对比伤椎固定结合硫酸钙椎体成形术与单纯伤椎固定治疗胸腰椎爆裂骨折的临床疗效. 方法 2005年1月- 2008年10月对61例胸腰椎爆裂骨折患者分别采用伤椎固定结合硫酸钙椎体成形(A组)与单纯伤椎固定(B组)进行治疗.A组32例,其中男22例,女10例;年龄21～ 65岁,平均36.8岁.术后随访13 ～27个月...     

新型微创经皮椎弓根螺钉内固定治疗胸腰椎骨折

目的 评价新型微创经皮椎弓根螺钉(Sextant-R)内固定治疗胸腰椎骨折的效果.方法选择36例胸腰椎骨折患者分为Sextant-R组(14例)和开放手术组(22例),对比分析手术切口、手术时间、出血量以及后凸畸形矫正率等.结果 Sextant-R组手术切口长度(7.1±0.9)cm,手术时间(1.1±0.7)h,出血量(89.3±12.1)ml,术后引流量(12.6 ±3.2)ml,术后平均Cobb角(4.5±2.4)°,术后椎体矢状而指数(10.2±10.1)°,术后伤椎椎体前缘高度(85.0±7.0)%.开放手术组手术切口长度(16.8±1.6)cm,手术时间(2.4±0.8)h,出血量(325.0±123.6)ml,术后引流量(147.3±36.1)ml,术后Cobb角(1.0±2.3)°,术后椎体矢状面指数(5.5±8.6)°,术后伤椎椎体前缘高度(95.5±2.2)%.结论 在严格掌握手术适应证的前提下,Sextant-R内固定是治疗胸腰椎骨折的较好选择.     

经伤椎翘拨复位植骨内固定治疗胸腰椎爆裂性骨折的临床效果观察

目的 评价经伤椎翘拨复位植骨、椎弓根螺钉内固定治疗胸腰椎爆裂性骨折的临床效果.方法 2013年1月-2013年12月共57例胸腰椎爆裂性骨折患者在成都军区总医院行经伤椎翘拨复位植骨、椎弓根螺钉内固定术,记录和观察患者围术期基本情况及并发症,记录术前、术后l周和末次随访时患者的疼痛视觉模拟评分(VAS)及神经功能情况(ASIA分级),测量术前、术后1周和末次随访时的伤椎前缘压缩率、伤椎后缘压缩率、椎管狭窄率和Cobb角并进行统计学分析.结果 57例患者均顺利完成手术,手术时间70～120min,出血量120～280ml,术中无脊髓、神经损伤,无硬膜撕裂.所有患者均获随访,随访时间12～36个月,患者神经功能较术前有明显恢复.末次随访X线片及CT示椎体骨折均愈合,内固定位置良好,未见明显松动迹象.术后1周和末次随访时的VAS、伤椎前缘压缩率、伤椎后缘压缩率、椎管狭窄率、Cobb角与术前相比差异均有统计学意义(P＜0.05),而术后1周与末次随访时比较差异均无统计学意义(P＞0.05).结论 经伤椎翘拨复位植骨、椎弓根螺钉内固定可以有效地恢复伤椎的高度和减轻椎管内压迫,有利于后凸畸形的矫正和脊髓功能的恢复.该方法可以很好地维持伤椎高度,显著降低了远期椎体塌陷的风险.     

Stress MR imaging for evaluation of popliteal artery entrapment

The popliteal artery entrapment (PAE) syndrome has been recognized as a cause of arterial occlusion in young people. It is the result of an anomaly of the relationship between the popliteal artery and the gastrocnemius muscle. Eight young healthy volunteers (16 legs) and six patients (10 legs) with suspected PAE underwent magnetic resonance (MR) imaging. Gradient-echo images were obtained in axial planes with the leg at rest and during active plantar flexion against resistance. Imaging at rest allowed identification of PAE signs in only one leg, which had an anomalous medial course of the popliteal artery. In the other cases, only the stress technique was able to show signal loss in the popliteal artery due to muscular compression (two legs) or the presence of accessory muscle slip around the vessel (two legs), as confirmed at surgery. MR imaging is therefore a useful technique for the diagnosis of PAE because of its capability of combining information obtainable with other modalities.     

MR imaging of muscle and tender points in fibromyalgia

Fibromyalgia is a syndrome manifested by chronic, diffuse muscu-loskeletal aching and soreness, palpable muscle tender points, and other symptoms. Standardized clinical diagnostic criteria have recently been developed. Skeletal muscle has been postulated as the end organ in this disease. Biochemical, histologic, electromyographic, and conventional radiographic studies have demonstrated no definitive abnormality. This study sought to establish whether magnetic resonance (MR) imaging could demonstrate any abnormality in these patients. Eighteen patients were entered in the study, 14 of whom were able to complete their examinations. T1 -weighted, T2-weighted, gradient-echo, and STIR (short-tau inversion-recovery) sequences were performed in all patients, with selected patients examined with T1weighted, gadopentetate dimeglu-mine-enhanced sequences. The trapezius and suboccipital regions were imaged in patients who, clinically, had active fibro-myalgia. No abnormalities could be detected. The authors conclude that the conventional MR imaging used in this study was unable to depict any primary skeletal muscle abnormality in fibromyalgia.     

Uterine contractions: Possible diagnostic pitfall at MR imaging

A total of 206 nongravid patients with various gynecologic problems underwent pelvic magnetic resonance (MR) examinations that included both sagittal T2-weighted and contrast agent–enhanced T1-weighted images. MR images were retrospectively reviewed to identify changes in endometrial configuration on serial images obtained during the same MR examination. In 20 MR examinations (all in women of reproductive age), endometrial distortion due to myometrial bulging was noted on T2-weighted or contrast-enhanced T1-weighted images. It was absent on other MR images obtained at different times. Myometrial bulging exhibited low signal intensity in 18 examinations. The finding resembled adenomyosis or leiomyoma on T2-weighted or contrast-enhanced T1-weighted images. These results evidence the presence of transient myometrial bulging and transient low-intensity myometrium in the nongravid uterus. This phenomenon is thought to represent uterine contraction. Clinicians should be aware of the potential presence of transient low-signal-intensity myometrial bulging that could present diagnostic problems in the normal uterus.     

Controversies in cervical spine imaging in trauma patients

No area of emergency radiology has generated as much discussion in recent years as the subject of cervical spine imaging for trauma patients. This review will be in three parts. The first will examine the indications for cervical imaging and will focus on those factors that make patients at high risk or low risk for cervical injury. The second part will discuss the merits of radiography and computed tomography as the main screening diagnostic examination. In addition to the roles of each modality in the evaluation process, such factors as efficacy of diagnosis, time (duration) of study, and cost will be discussed. Finally, the third part will explore the methods currently employed to clear the cervical spine in comatose patients.Presented at the Annual Meeting of the American Society of Emergency Radiology, Las Vegas, Nevada, 22–25 October, 2003     

Brodie Abscess: MR imaging appearance in 10 patients

The magnetic resonance (MR) imaging features of Brodie abscess have not yet been fully evaluated. Ten patients with Brodie abscess, eight of long bone and two of vertebra, were studied with MR imaging. Long bone abscess had a characteristic “target” appearance with four layers: (a) a center with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR (short-inversion-time inversion recovery) images, (b) an inner ring isointense to muscle on T1-weighted images and with high signal intensity on T2-weighted and STIR images, (c) an outer ring hypoin-tense on all images, and (d) a peripheral halo hypointense on T1-weighted images. In six of eight cases, a soft-tissue mass was found. The two vertebral abscesses had a less specific appearance, with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR images. Only the peripheral halo was clearly identified in both cases.     

Dynamic contrast-enhanced MR imaging assessment of vascularized free fibular grafts

Magnetic resonance (MR) imaging may be a noninvasive method for assessing perfusion of vascularized bone grafts placed for treatment of avascular necrosis. One proximal femur of seven beagles was devascularized, with insertion of a vascularized fibular graft. MR imaging at 1 week (seven dogs) and 6 weeks (five dogs) after surgery included pre- and postcontrast spin-echo sequences, unenhanced twodimensional time-of-flight (TOF) vascular imaging, and dynamic gradient-echo imaging during infusion of gadolinium. Relative signal intensity values of selected regions obtained from the dynamic gradientecho images were plotted as percent enhancement versus time. In the operated hip, MR imaging did not show enhancement in six of seven femoral heads and greater trochanters at 1 week after surgery, with similar results after 6 weeks. MR imaging of fibular grafts 6 weeks after surgery showed an initial rapid increase in enhancement and a subsequent slower increase in five of five dogs, although no enhancement was seen in six of seven dogs at 1 week. These findings contrasted with a rapid initial increase in enhancement followed by slow decline in non-operated hips. Two-dimensional TOP imaging did not show the vascular pedicle of the graft in any dog. Findings of radionuclide bone scanning performed 1 week after surgery were consistent with devascularization of the operated femur and fibular graft. However, tetracycline distribution and histologic findings confirmed the viability of five of five grafts within the devascularized femurs 6 weeks after surgery. Thus, dynamic contrast-enhanced MR imaging at 6 weeks after surgery is valuable for assessing vascular bone graft perfusion, while similar imaging at 1 week may suggest otherwise.     

Right-side aortic arch with aneurysm of aberrant left subclavian artery: MR imaging appearance.

Reports of aneurysms of the subclavian artery in both normal and anomalous aortic arches have been rare. The authors describe a patient with a right-side aortic arch and an aneurysm of the aberrant left subclavian artery, which, to the authors' knowledge, is a previously unreported association. At presentation, the aneurysm appeared as a calcified left superior mediastinal mass. Magnetic resonance imaging enabled preoperative diagnosis and guided surgical planning.     

Adrenal tissue characterization with 0.5-T MR imaging: Value of T2*-weighted images

The authors investigated the value of magnetic resonance (MR) imaging at 0.5 T for distinguishing adrenal adenomas from adrenal metastases. The series included 23 adrenal adenomas (18 nonhyperfunctioning, five hyperfunctioning) and 23 adrenal metastases from various organs. Adrenal tumor–liver signal intensity ratios on T1-, T2-, and T2*-weighted images were calculated for adrenal tissue characterization. Adrenal adenomas were more precisely distinguished from adrenal metastases on T2*-weighted images (21 of 23, 91%) than on T2-weighted images (15 of 23, 65%). T1-weighted images were not useful for this distinction. In conclusion, T2*-weighted images were better than routine T2-weighted images for distinguishing adrenal adenomas from adrenal metastases. It can be postulated that the total signal intensity of adrenal adenomas, which contain some fat components, decreased on T2*-weighted images because of an out-of-phase effect.     

MR angiography of congenital heart disease: Value of segmented two-dimensional inflow technique and maximum-intensity-projection display

Magnetic resonance (MR) angiography of the cardiovascular system was evaluated in 41 patients with congenital heart disease by using a two-dimensional (2D) inflow technique based on a magnetization-prepared gradient-echo pulse sequence with segmented k-space data acquisition and electrocardiographic gating at 0.5 T. Inversion and saturation prepulses were used to suppress stationary tissue and enhance intravascular signal. Presaturation slabs were applied where certain vascular structures had to be suppressed. Sequence parameters were optimized by evaluating signal intensity and contrast characteristics for various flip angles and inversion and saturation delay times. The heart and intrathoracic vasculature were encompassed with 40–50 overlapping sections. Both 2D angiograms and maximum-intensity-projection images were evaluated. Combining data sets acquired in the sagittal and transverse orientations provided the most satisfactory information about the pulmonary arteries. The highest signal-to-noise ratios were obtained with a flip angle of 65° and short prepulse delay times. Two-dimensional MR angiography can provide useful diagnostic information but requires a thorough understanding of in-plane and hemodynamically induced signal intensity changes.