纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体在骨质疏松性胸腰椎爆裂骨折前路手术中的应用

背景：胸腰椎前路手术中,植入物塌陷是影响胸腰段骨折患者疗效的重要因素之一,尤其是骨质疏松患者发生植入物塌陷、钉道松动、植骨不愈合、脊柱后凸畸形的缺陷更加明显。纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体具有良好的生物相容性及生物安全性,是一种比较理想的椎体植骨替代材料。 目的：观察纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体治疗骨质疏松性胸腰椎爆裂骨折的疗效。 设计、时间及地点：回顾性病例分析,病例来自于2004-01/2008-01泸州医学院附属医院脊柱外科。 对象：20例中重级骨质疏松性胸腰椎骨折患者,男6例,女14例;年龄51~82岁,平均69岁。新鲜骨折17例,陈旧性骨折3例。纳米羟基磷灰石/聚酰胺66复合人工椎体为四川国纳科技有限公司生产,该人工椎体直径10~35 mm,长度30~ 100 mm,呈圆柱状,中空直径3~12 mm,管壁厚度2.5~6.5 mm,椎体四周为直径2 mm小孔,人工椎体接触面积为78.5~176.7 mm2。固定物为佛山施太保公司的前路钉板系统,系钛合金材料。 方法：常规气管插管全麻,取右侧卧位,根据骨折累及的节段不同而选用不同部位的切口,行前路减压、纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体支撑,钢板内固定。 主要观察指标：X射线片观察骨折愈合情况、植入体松动情况,并比较术前、术后3个月及末次随访时的Cobb角、伤椎高度及脊髓功能评分。 结果：所有患者均顺利完成手术,术中出血 200~800 mL,手术时间2.0~3.0 h,术后患者肺部感染1例,伤口延迟愈合1例。20例患者均获得随访,随访时间6~42个月(平均18个月)。术后X射线片复查显示相邻椎体三四个月愈合,植入体无明显移位,重建的椎体高度丢失少。内固定位置良好,无断钉断棒及内固定松动移位等现象。术后3个月Cobb角、伤椎高度及脊髓功能评分与术前比较差异有显著性意义(P < 0.05),而术后两次随访差异无显著性意义(P > 0.05)。 结论：纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体应用于骨质疏松性胸腰椎爆裂骨折前路手术可增大植骨融合面积,减少局部压强,防止植入体松动下沉,有效恢复椎体的高度。 关键词：胸腰椎爆裂骨折;骨质疏松;生物材料;人工椎体     

比较纳米羟基磷灰石/聚酰胺66人工椎体与自体髂骨在颈椎前路减压融合中的应用

摘要 背景：目前用于颈椎前路重建的材料较多,如自体髂骨、同种异体骨、钛网等,但各种材料均存在一定的不足。纳米羟基磷灰石/聚酰胺66人工椎体具有良好的生物相容性及生物安全性,是一种比较理想的椎体植骨替代材料。 目的：评估纳米羟基磷灰石/聚酰胺66人工椎体应用于颈椎前路减压融合治疗脊髓型颈椎病的临床效果,并与自体髂骨进行对比。 方法：2009-01/2010-03对40例脊髓型颈椎病患者行颈前路椎体次全切减压融合钛板内固定。22例行纳米羟基磷灰石/聚酰胺66人工椎体植骨,18例行自体髂骨块植骨,采用JOA评分法评价神经功能的恢复情况,测量Cobb角评价融合节段曲度以及融合节段椎体前缘、后缘高度。 结果与结论：患者均获得 6~14个月随访,JOA评分较治疗前明显改善。人工椎体组及自体髂骨组融合节段后缘高度和前凸Cobb角治疗后3个月与治疗后即刻差值、治疗后6个月与治疗后3个月差值差异均有显著性意义(P < 0.01)。根据融合标准,治疗后6个月两组融合情况差异无显著性意义(P > 0.05)。提示纳米羟基磷灰石/聚酰胺66人工椎体作为颈椎前路植骨材料,融合率同自体髂骨相似,可以有效保持颈椎生理曲度及椎间高度,长期效果有待进一步观察。 关键词：纳米羟基磷灰石/聚酰胺;颈椎病;自体髂骨;前路植骨融合;Cobb角 doi:10.3969/j.issn.1673-8225.2011.12.026     

纳米羟基磷灰石/聚酰胺66复合生物活性材料构建的人工椎体治疗脊柱疾病

目的：比较纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体和自体髂骨重建椎体在脊柱疾病临床应用的安全性和疗效。 方法：以“纳米羟基磷灰石/聚酰胺66,人工椎体,自体髂骨重建椎体,脊柱疾病”为中文关键词;“the bioactive artificial vertebral body,spine diease”为英文关键词。采用计算机检索1969-01/2009-12相关文章。纳入与有关人工椎体相关的文章;排除重复研究或Meta分析类文章。以13篇文献为主重点进行了讨论。临床验证选择：重庆市第二人民医院骨科收治的椎板、椎体缺损患者36例,按患者选用的置换物分为两组：观察组采用四川国纳科技有限公司生产的纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体;对照组使用自体髂骨重建椎体。比较2组术后3 d,1,2周检测白细胞计数、C-反应蛋白、血沉等炎性指标。术后1,2周检测肝功能、肾功能。术后 0,1,3,6个月复查 X射线片,术后 8,16周复查 CT。 结果与结论：人工椎体可分为2种：金属材料、复合材料;其中后者目前研制的有聚醚烷生物玻璃复合物、羟基磷灰石胶原蛋白混合材料和磁性生物陶瓷人工椎体3种。临床验证结果：所有患者未出现切口渗液,发热,皮疹等免疫排斥反应,切口 Ⅰ期愈合。两组术后白细胞计数、C-反应蛋白,血沉等炎性指标和检测肝功能、肾功能差异无显著性意义(P > 0.05)。术后8周CT显示两组骨传导性能、成骨性差异均无显著性意义。6个月复查 X射线片,人工椎体、椎板、周围骨质未见吸收征。提示纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体在治疗脊柱疾病中应用安全有效,其短期疗效与自体髂骨重建椎体相似。     

钛质外科网和纳米仿生骨在颈椎前路减压融合中的应用*

摘要 背景：纳米羟基磷灰石/聚酰胺作为新型植骨材料,应用于颈椎前路减压融合中,不仅可以减少患者取骨带来的并发症,而且具有稳定的植骨融合率。 目的：比较钛网和纳米羟基磷灰石/聚酰胺应用于颈椎前路减压融合治疗脊髓型颈椎病的临床效果。 方法：对确诊的48例脊髓型颈椎病患者行颈前路椎体次全切减压融合钛板内固定。其中26例行钛网植骨,22例行纳米羟基磷灰石/聚酰胺仿生骨植骨,采用JOA评分法评价神经功能的恢复,测量cobb角评价融合节段曲度。 结果与结论：48例患者均获得随访,随访时间6~14个月。置入后3个月JOA评分较置入前明显改善,两组对比JOA评分差异无显著性意义;置入后3,6个月钛网组及仿生骨组融合节段cobb角相对于置入后即刻变化差异有显著性意义,两组对比差异无显著性意义;置入后3个月钛网组2例患者出现钛网沉降,融合节段椎间高度丢失。结果表明纳米羟基磷灰石/聚酰胺仿生骨作为颈椎前路融合植骨材料,融合率高,可以有效保持颈椎生理曲度及椎间高度,长期效果有待进一步观察。 关键词：颈椎病;钛质外科网;纳米羟基磷灰石/聚酰胺;前路植骨融合;生物相容性 doi:10.3969/j.issn.1673-8225.2011.03.008     

人工椎体的组织相容性和力学性能

背景：近年来,随着组织工程学的发展,椎体替代材料趋于多样化,学者们不再满足于其能否恢复椎体高度与即刻稳定性,而是更为关注远期的融合,良好的组织相容性和力学性能。 目的：分析国内人工椎体的组织相容性和力学性能。 方法：以“人工椎体、相容性、生物力学”为检索词在中国期刊全文数据库中检索与人工椎体生物相容性和生物力学研究相关的文献进行分析。 结果与结论：人工椎体组织相容性的动物实验显示,纳米羟基磷灰石/聚酰胺66复合人工椎体成分和结构与人体骨相似,具有良好的生物相容性,成骨活性;可发生生物降解,其降解作用与成骨能力匹配。人工椎体的生物力学研究显示出纳米羟基磷灰石/聚酰胺66复合人工椎体不仅具有良好的生物活性,而且具有良好的轴向压缩载荷和椎间支撑能力,力学性能优异。生物陶瓷人工椎体不仅具有良好的生物相容性,而且在治疗椎体肿瘤中有靶向定位作用;金属材料的人工椎体经过多年的改进,其生物相容性亦可满足临床要求。就各类型人工椎体优劣而言,仍需进一步大量研究和实践,就其临床应用而言,需根据临床需要进行选择。     

纳米羟基磷灰石/聚酰胺66颈前路减压后前方骨缺损仿生髂骨的制备及性能

背景：在椎体和椎间盘切除以后,对于减压后前方骨缺损的修补长期以来以钛网和自身髂骨两种方式为主,但效果都不尽理想。 目的：制备纳米羟基磷灰石/聚酰胺66复合材料,对其进行表征和生物力学性能检测。 设计、时间及地点：重复性对比实验,于2008-01/12在南京航空航天大学材料科学与技术学院无机材料实验室完成。 材料：利用水热反应法制备纳米羟基磷灰石晶体,通过液相混合、冷压烧结制备出纳米羟基磷灰石/聚酰胺66仿生骨块。 方法：切除新鲜冰冻正常颈椎标本C5椎体,植入不同材料,钢板螺钉内固定,进行生物力学测试。具体分组为：正常颈椎组、纳米羟基磷灰石/聚酰胺66仿生髂骨钢板螺钉内固定组、髂骨植骨钢板螺钉内固定组。加载时模拟人体颈椎生理运动,即中心位、前屈位、后伸位和侧屈位4种生理情况。 主要观察指标：①通过X射线衍射仪对材料的物相进行表征。②红外图谱对材料的基团构成进行表征。③扫描电镜观察仿生骨的端口形貌。④正常颈椎、仿生髂骨、髂骨植骨进行生物力学检测。 结果：①X射线衍射结果表明纳米羟基磷灰石和聚酰胺66的主要衍射峰在复合材料中存在,但纳米羟基磷灰石对聚酰胺66的β晶型衍射峰起到宽化、削弱的作用。②红外图谱表明两者之间存在氢键。③扫描电镜观察,两者结合密实,界面性能优异。④通过生物力学实验,对比得出,仿生髂骨在载荷-应变变化、载荷-位移变化、应力强度方面都优于髂骨植骨,仅次于正常颈椎骨。 结论：所制备的纳米羟基磷灰石/聚酰胺66仿生骨力学性能优异,是一种理想的颈椎替代材料。 关键词：纳米羟基磷灰石/聚酰胺66;生物复合材料;生物力学性能;髂骨植骨;颈前路手术     

骨修复用纳米羟基磷灰石/聚酰胺66的体内外生物相容性

背景：采用基于纳米羟基磷灰石溶胶新方法制备纳米羟基磷灰石/聚酰胺66复合材料,该材料提高了纳米羟基磷灰石在聚酰胺66基体中的均匀分布和二者的有效键合,进而有利于改善材料的生物性能,有望成为新型骨修复材料。 目的：评价纳米羟基磷灰石/聚酰胺66复合材料体内外生物相容性。 方法：①将原代培养的成骨细胞与纳米羟基磷灰石/聚酰胺66及聚酰胺66材料复合培养,使用倒置相差显微镜和场发射扫描电子显微镜观察材料周围及表面的细胞形态。②将纳米羟基磷灰石/聚酰胺66复合材料植入兔右侧胫骨,将聚酰胺66作为对照组材料植入兔左侧胫骨。在术后2,8周,取材料周围骨组织进行病理组织切片观察。 结果与结论：①纳米羟基磷灰石/聚酰胺66和聚酰胺66未表现出明显的细胞毒性,纳米羟基磷灰石/聚酰胺66材料周围细胞形态好于聚酰胺66,且纳米羟基磷灰石/聚酰胺66表面细胞数量多于聚酰胺66,在复合培养的第3天差异尤其显著(P < 0.01)。②在植入早期,与纳米羟基磷灰石/聚酰胺66相接的骨组织成骨细胞活跃且该组材料周围的骨形成过程较对照组更快。结果说明纳米羟基磷灰石/聚酰胺66复合材料较聚酰胺66有更好的生物相容性。 关键词：纳米羟基磷灰石/聚酰胺66;聚酰胺66;生物相容性;细胞培养;骨修复材料 doi:10.3969/j.issn.1673-8225.2010.08.044     

后正中入路Dynesys置入对腰椎全椎板减压术后生理性稳定性的作用

目的：探讨经后正中入路切除腰椎椎管内神经鞘瘤同时行腰椎动态稳定重建系统（ Dynesys ）置入对重建脊柱生理性稳定的作用。方法对采用后正中入路全椎板切除上腰椎椎管内神经鞘瘤的6例患者,术后应用腰椎Dynesys进行脊柱稳定性重建。结果神经鞘瘤均完整切除。术后1周、3个月、6个月时X线片复查示腰椎过伸、过屈位各椎体活动度良好,椎间隙等宽;内置物位置良好,无临近节段退变、脊柱失稳、椎体滑脱现象。结论对腰椎椎管内神经鞘瘤采用全椎板切除后置入Dynesys能够充分暴露肿瘤所在区域的视野,完整切除神经鞘瘤,有效避免损伤脊髓神经。 Dynesys既能达到传统强直融合的脊柱稳定性,还能够有效重建生理性稳定,防止临近节段脊椎发生退变。     

生物陶瓷人工椎体以及脊柱前路解剖型钢板重建椎体的生物力学评价☆

目的：基于胸腰椎解剖学的研究，设计制作了胸腰椎脊柱前路解剖型固定钢板以及生物陶瓷人工椎体，并对应用脊柱前路解剖型固定钢板，Kaneda装置以及生物陶瓷人工椎体等技术重建椎体的动物脊柱标本进行了生物力学测试比较。 方法：实验于2001-10/2002-06在华中科技大学力学系国家重点试验室完成。选取正常成年新鲜牛脊柱标本40具，由华中科技大学力学系试验室提供, 分为正常组，生物陶瓷人工椎体组，脊柱前路解剖型固定钢板加植骨组，Kaneda装置加植骨组，单纯植骨不加任何外固定组。应用与华中科技大学力学系联合研制的生物力学测试系统，采用动态加载，应用传感器动态记录方式，对各组牛脊柱标本进行三维六度的测试分析。 结果：①单纯植骨不加任何外固定组在各个方向均最不稳定。②脊柱前路解剖型固定钢板在前屈，后伸方向明显较Kaneda装置稳定。③在Kaneda装置的对侧即右侧：脊柱前路解剖型固定钢板在右旋，右弯方向与Kaneda装置固定效果相当，甚至稍强。④在Kaneda装置的固定侧即左侧，脊柱解剖型固定钢板的稳定性稍弱于Kaneda装置。⑤生物陶瓷人工椎体的固定效果各个方向均较为理想，明显地高于Kaneda装置固定、脊柱前路解剖型钢板的固定，与正常脊柱相当。 结论：应用生物陶瓷人工椎体以及脊柱前路解剖型钢板重建椎体具有良好的生物力学稳定性。     

钛网置入与全脊椎切除在重建严重脊柱畸形椎体中的应用

背景：不论是传统的单纯前路凹侧支撑、前路松解联合后路矫形,还是近年来较多学者提倡的经后路脊柱闭合楔形截骨等方法,均不能有效治疗临床严重僵硬脊柱侧后凸畸形。 目的：总结经后路全脊椎切除应用于严重角状侧凸或/和后凸畸形的临床经验,观察该方案以及钛网置入对患者脊髓功能的影响。 方法：回顾性分析2004-10/2008-12采用全脊椎切除治疗的脊柱畸形病例中,畸形呈角状的侧凸或/和后凸,主弯角度在冠状面或/和矢状面上测量>100º,且畸形的柔韧度小于10%的15例患者。脊髓功能2例Frankel 评分为D,余均为E级。采用肋骨横突切除入路显露,结扎顶椎区节段血管,置入椎弓根钉,完成全脊椎切除后采用交替换棒技术,并置入钛网,以此获得矫形。治疗过程中未使用感觉或运动诱发电位监测。治疗后随访普通X射线片Cobb角矫正与神经功能变化。 结果与结论：平均术中切断(3.8±1.4)支节段血管。治疗后测量侧凸及后凸畸形矫形率分别为60.8%和72.9%。随访6~48个月,至随访终末所有病例Frankel 评分E级,部分患者治疗前存在的肌张力增高及肛门括约肌松弛等均恢复正常,内固定物无脱落、松动等。提示严重且僵硬的角状脊柱畸形患者,采用经后路全脊椎切除加椎弓根钉棒系统内固定可获得良好矫形效果。在稳定的力学环境和直视保护下,脊髓可耐受一定范围的短缩、成角和旋转位移。通过对脊髓的环周减压,保持脊髓等张或短缩状态的矫形,利于病态脊髓的功能恢复。     

A hollow cylindrical nano-hydroxyapatite/polyamide composite strut for cervical reconstruction after cervical corpectomy

This retrospective study included 35 patients who had a nano-hydroxyapatite/polyamide (n-HA/PA) composite strut implanted for cervical reconstruction and fusion after corpectomy from 2006 to 2008. The average follow-up period was 38.5 months (range: 24-48 months). The Japanese Orthopedic Association score and visual analog pain scale score were significantly improved and maintained to the last follow-up. The cervical curvature and the height of fused segments were also corrected significantly and retained to the last follow-up. A total of 94.3% of patients had achieved radiographic bony fusion at the postoperative 24-month follow-up. One patient presented with subsidence of the n-HA/PA composite strut and dislodgement of the screws, but the patient had no discomfort and no additional surgery was needed. We conclude that the n-HA/PA composite strut is scientifically and technically sound for cervical reconstruction and interbody fusion after corpectomy with anterior plate fixation.     

Eosinophilic granuloma of C4 causing spinal cord compression

A rare case of vertebral eosinophilic granuloma (C4) causing spinal cord compression is reported. The clinical, histological and radiological features of this pathological entity are discussed. After surgery a complete neurological recovery was observed. The value, in selected cases, of surgical treatment with total removal of the tumour and reconstruction of the spine to ensure spinal stability and to prevent irreversible neurological deficit is emphasized.     

Cervical intradural ventral arachnoid cyst resected via anterior corpectomy with reconstruction: a case report

Intradural arachnoid cysts are rare lesions that frequently arise posterior to the spinal cord in the thoracic spine region. Those located at the cervical spine level, anterior to the spinal cord are even rarer. The usual treatment of symptomatic intradural spinal cysts involves surgical removal through a posterior approach using a laminectomy or laminotomy. However, ventrally located intradural cysts are frequently not amenable to complete resection without undue manipulation of the cord and aggressive removal through a posterior approach may result in spinal cord injury. The authors present a 29-year-old male harbouring an intradural ventral cervical arachnoid cyst which was successfully resected via an anterior approach with corpectomy and reconstruction. CONCLUSION: For purely ventral cervical intradural arachnoid cysts, which compress the spinal cord dorsally, an anterior approach can allow access to the lesion without any need for intraoperative manipulation of the spinal cord. For such cases, the anterior approach prevents the consequent risk of neurological injury due to posterior approaches.     

Surgical treatment of thoracic spinal tumours

BACKGROUND AND PURPOSE: The aim of the study is to present the authors' experience with the treatment of metastatic tumours of the thoracic spine regarding surgical strategy depending on extent of neoplastic invasion. MATERIAL AND METHODS: Between January 2002 and August 2005, 15 patients with thoracic spinal tumours underwent surgical treatment with instrumental stabilization at the Department of Neurosurgery, Warsaw Medical School, Poland. Seven patients with tumours localized in vertebral bodies or vertebral bodies and pedicles were operated on via an anterior approach with concomitant stabilization at the same operative procedure. In 5 patients with metastatic involvement of vertebral arches and pedicles, a posterior approach for tumour removal was used with concomitant posterior fixation at the same operative procedure. Two patients with multiple spine metastases underwent internal fixation at the level corresponding to the observed symptoms. In 1 patient with bilateral lung cancer and vertebral body involvement, posterior stabilization with decompression of nervous structures was performed. RESULTS: None of the patients neurologically deteriorated after surgery. All patients with neurological deficits improved while one patient with pain syndrome did not. In 1 case approach-related surgical complications were observed. CONCLUSIONS: Regarding the complexity of surgical treatment of spinal metastases, the presented material is clearly not sufficient to draw firm conclusions. However, according to the authors' experience, the treatment of choice in single spinal metastasis involving the vertebral body is tumour removal via an anterior approach followed by adjunctive therapy. In metastatic lesions localized in vertebral pedicles and arches, removal via a posterior approach with concomitant posterior stabilization at the same operative procedure and adjunctive therapy is most indicated. Posterior stabilization of the spinal cord segment corresponding with symptoms is considered an appropriate surgical treatment of multiple spinal metastases.     

Rib-head osteotomies for posterior placement of expandable cages in the treatment of metastatic thoracic spine tumors

Metastatic spine tumors commonly affect the thoracic spine, and effective tumor control often requires corpectomy with reconstruction. In some instances, anterior approaches for corpectomy may be difficult or less than ideal because of medical co-morbidities, pulmonary disease or difficult access behind the mediastinum. Thus, posterior approaches are commonly used for corpectomies with anterior column reconstruction in the thoracic spine. Expandable cages have the advantage of restoring height, correcting kyphosis, and providing secure wedging between the vertebral bodies. However, the spinal cord and thorax may prevent direct, easy access for placement of expandable cages. Reconstruction has been performed with different materials; however, expandable cages have hitherto been less frequently used because of their size and difficulty expanding the cages posteriorly. We describe a technical note that may facilitate the placement of an expandable cage in the thoracic spine after posterior transpedicular corpectomies.     

Excision of high and mid cervical spinal cord arteriovenous malformations by anterior operation.

Symptomatic cervical spinal arteriovenous malformations (AVMs) located on the anterior aspect of the spinal cord are rare and surgical removal of these AVMs presents considerable challenges and risks. Surgical techniques to date have usually been by posterior approach and lateral dissection around the cord or via midline myelotomy, both approaches involving cord manipulation and retraction and in the latter, dissection through the spinal cord. We present two teenage patients with symptomatic anteriorly placed mid to high cervical spinal AVMs and associated aneurysm in which excision of the AVMs and aneurysm was performed by an anterior approach using vertebrectomy/corpectomy. The first case had a small perimedullary glomus-type AVM with an aneurysm on the anterior aspect of the cord at the C3/4 level; excision was performed using a single level vertebrectomy/corpectomy, the patient remaining neurologically intact. The second case had a medium-sized juvenile AVM with an aneurysm, both perimedullary and intramedullary, centred at the C5/6 level; excision was performed using a two-level vertebrectomy/corpectomy with no deterioration in the marked pre-operative tetraparesis, which at long-term follow up had improved and stabilised. Anterior approaches have been recently described for treatment of anteriorly placed cervical arteriovenous fistulas (AVFs) and an intramedullary haemangioblastoma, but not as yet for spinal AVMs. These are the first two reported cases of anteriorly situated cervical AVMs successfully removed surgically by an anterior approach and with good neurological outcomes.     

Biomechanical effect of the extent of vertebral body fracture on the thoracolumbar spine with pedicle screw fixation: an in vitro study.

A fractured vertebra does not transfer load as effectively as the intact vertebra. Patients who undergo surgery using short-segment pedicle screw instrumentation for middle-column injury may experience implant failure when vertebral body comminution is ignored. The purpose of this study was to investigate biomechanical effects of the extent of vertebral body fracture on the thoracolumbar spine after pedicle screw fixation and to evaluate the biomechanical role of anterior reconstruction. Twelve fresh porcine T12-L3 specimens were harvested and divided into two groups. A 2-mm drill bit was used to create holes in the L1 vertebra with two different extents: 1/6 and 1/3 vertebral body involvement. After the pre-injury had been created, specimens were subjected to flexion-compression to create a fracture in the body of the spine. Stiffness under axial-compression and flexion-compression were measured in intact specimens, after the fractured segments had been stabilized using transpedicular fixation, and after transpedicular fixation with anterior grafting. Despite fixation of the injured spine with pedicle screw instrumentation, the axial-compression and flexion-compression stiffness was still significantly lower than that of the intact group (p<0.01). The stiffness was associated with the extent of vertebral body involvement; 1/6 vertebral body involvement was stiffer than the 1/3 involvement (p<0.01). Additional anterior grafting significantly improved stiffness compared with posterior fixation alone (p<0.01), and restored stiffness to the intact level. In any state, stiffness under axial-compression was always significantly greater than that under flexion-compression (p<0.01). In conclusion, transpedicular fixation alone cannot provide sufficient stability for thoracolumbar fractures; the construct stability is related to the extent of vertebral body involvement. Recovering mechanical properties of the anterior and middle spinal column is a valuable measure for reducing the load-sharing of the posterior instrument.     

无骨折脱位型颈脊髓损伤3种金属置入物疗效观察

背景：近年来,随着解剖学、影像学、外科技术的发展及国内外学者研究的深入,无骨折脱位型颈脊髓损伤的相关治疗取得了长足进步。 目的：观察前路重建脊柱稳定、后路减压+侧块固定、前路重建脊柱稳定+后路减压治疗无骨折脱位型颈脊髓损伤的效果。 方法：回顾性分析2003-10/2005-12解放军广州军区广州总医院脊柱外科收治的无骨折脱位型颈脊髓损伤患者27例,男22例,女5例,均伤后7 d内入院,并行手术治疗。根据患者的损伤情况采用3种方式,前路减压重建脊柱稳定,后路单开门+侧块固定,前路重建脊柱稳定+后路减压。疗效评价标准采用Frankel分级及JOA评分计算改善率。 结果与结论：全部患者均获得随访,随访时间6~33个月,平均18个月。影像学复查提示减压充分,内固定固定良好,未见松动滑脱、断裂等现象,融合节段1年后均获得良好骨性融合。27例患者出院时神经系统症状均有不同程度改善。除1例Frankel A级患者无明显恢复外,其余均恢复1~4级。置入后JOA评分较置入前有明显改善,其中前路减压重建脊柱稳定组改善率为50%,后路单开门+侧块固定组改善率为53%,前路重建脊柱稳定+后路减压组改善率为51%。所有病例置入中未出现血管、神经损伤等并发症,随访中亦无并发症发生。提示根据无骨折脱位型颈脊髓损伤的不同特点,采取合理方式,可获得较好疗效。     

Primary Eosinophilic Granuloma of Adult Cervical Spine Presenting as a Radiculomyelopathy

We report a case of 29-year-old man diagnosed as a primary eosinophilic granuloma (EG) lesion of the seventh cervical vertebra. He had paresthesia on both arms, and grasping weakness for 10 days. Cervical magnetic resonance image (MRI) showed an enhancing mass with ventral epidural bulging and cord compression on the seventh cervical vertebra. Additionally, we performed spine series MRI, bone scan and positive emission tomography for confirmation of other bone lesions. These studies showed no other pathological lesions. He underwent anterior cervical corpectomy of the seventh cervical vertebra and plate fixation with iliac bone graft. After surgical management, neurological symptoms were much improved. Histopathologic evaluation confirmed the diagnosis of EG. There was no evidence of tumor recurrence at 12 months postoperative cervical MRI follow-up. We reported symptomatic primary EG of cervical spine successfully treated with surgical resection.