胸椎管狭窄症后路减压术及并发症探讨

目的 探讨胸椎管狭窄症的手术方法及并发症的产生原因。方法 对胸椎管狭窄症15例患者采用后路减压术。结果 随访3个月－2年4个月，其中优4例，良8例，优良率80％，可1例，差1例，加重1例，可能出现并发症的原因有：（1）使用器械不当；（2）硬脊膜撕裂；（3）缺血再灌注损伤；（4）定位不准确；（5）硬膜外血肿。结论 目前对于该病的治疗，手术减压是解决压迫，恢复脊髓功能唯一有效的方法。     

胸椎管狭窄症后路减压术及并发症探讨

目的　探讨胸椎管狭窄症的手术方法及并发症的产生原因。方法　对胸椎管狭窄症 15例患者采用后路减压术。结果　随访 3个月～ 2年 4个月 ,其中优 4例 ,良 8例 ,优良率为 80 % ,可 1例 ,差 1例 ,加重 1例。可能出现并发症的原因有 :①使用器械不当 ;②硬脊膜撕裂 ;③缺血再灌注损伤 ;④定位不准确 ;⑤硬膜外血肿。结论　目前对于该病的治疗 ,手术减压是解除压迫、恢复脊髓功能唯一有效的方法     

颈椎前路环钻减压融合术

自50年代Robinson介绍颈椎前侧手术入路以来,其已被广泛地用于颈椎间盘突出、退行性间盘病(spondylosis)和损伤的手术治疗。由于Robinson操作要求的器械条件较高(必须有高速气动钻),故国内颈椎前路减压术多采用较简便的Cloward环钻技术。但由于环钻技术操作的固有缺陷,使其在实际操作中会遇到许多问题。我科自1991年4月至     

一次性前后路手术在颈椎管狭窄并颈椎过伸性损伤中的应用

目的 探讨一次性前后路手术在颈椎管狭窄并颈椎过伸性损伤治疗中的临床效果.方法 选取2008年4月至2010年10月于本院治疗的27例颈椎管狭窄并颈椎过伸性损伤的患者为研究对象,将术后6个月以及一年后的JOA评分结果与手术之前进行比较.结果 手术后6个月JOA平均评分结果为(11.2±2.3)分、手术一年的JOA平均评分结果为(17.1±3.1)分,均明显高于手术之前的JOA平均评分结果(7.8±2.1)分,差异有统计学意义,P<0.05;手术后6个月脊髓功能改善率为29.6%、术后后1年脊髓功能改善率为48.1%.结论 一次性前后路手术治疗颈椎管狭窄并颈椎过伸性损伤临床效果良好,可以广泛推广.     

颈椎后路双开门异体骨植骨治疗颈椎管狭窄症(附12例报告)

颈椎管狭窄病例很多,治疗方法各异.近年来我们对多节段椎管狭窄采用了后路双开门异体骨植骨椎管扩大成形术,取得了很好效果,报道如下.1 资料与方法1.1 一般资料 1997～1999年共治疗12例,其中男10例,女2例;年龄40～70岁,平均50.3岁;病程3个月～10年,平均31个月.2例有外伤史.病变范围:4个节段4例,3个节段6例,2个节段2例;多数为3～4节段.     

前后路联合减压治疗重型颈椎管狭窄症临床分析

颈椎管狭窄与颈椎病的发生和发展有密切的关系[1],随着人口的老龄化,颈椎及间盘退行性变、颈椎肿瘤、后纵韧带骨化症及黄韧带肥厚钙化等原因所导致的颈椎管狭窄症发病率日趋增加,其中累及多个节段的颈椎间盘突出的颈椎病、后纵韧带骨化症、黄韧带肥厚钙化致颈椎管狭窄的比例已越来越大.我院2007年6月-2011年1月行前后路联合减压治疗重型颈椎管狭窄症27例,取得了满意效果.现报道如下.     

前后路联合减压治疗重型颈椎管狭窄症临床分析

颈椎管狭窄与颈椎病的发生和发展有密切的关系[1],随着人口的老龄化,颈椎及间盘退行性变、颈椎肿瘤、后纵韧带骨化症及黄韧带肥厚钙化等原因所导致的颈椎管狭窄症发病率日趋增加,其中累及多个节段的颈椎间盘突出的颈椎病、后纵韧带骨化症、黄韧带肥厚钙化致颈椎管狭窄的比例已越来越大。我院2007 年6 月 -2011 年1 月行前后路联合减压治疗重型颈椎管狭窄症 27 例,取得了满意效果。现报道如下。     

颈椎前后路联合手术治疗颈椎管狭窄合并损伤患者的护理

总结14例颈椎前后路联合手术治疗颈椎管狭窄并颈椎损伤患者的临床护理经验,对14例颈椎管狭窄并颈椎损伤的患者,术前缓解患者恐惧、忧虑、悲观情绪,改善营养较差患者的营养状况,指导患者做深呼吸、有效咳嗽;术后做好体位护理,防止植骨块脱出,严密监测生命体征,预防颈部血肿、脑脊液漏、气道阻塞、创口感染、褥疮等并发症;指导患者出院后3个月内颈部制动,在颈围保护和家属陪同下进行床旁活动。14例患者均获随访,平均随访13个月,脊髓损伤按Frankel分级术均有不同程度改善,损伤节段骨性融合,稳定性好,内植物无松动、脱落或断裂。     

颈椎管扩大成形术治疗颈脊髓压迫症

颈椎管扩大成形术治疗颈脊髓压迫症刘伟，杨华，方睿才，姚绍平不同原因引起的颈椎管狭窄而致脊髓压迫症的治疗，以往采用广泛颈椎板切除术，由于它的远期疗效不佳，可造成颈椎不稳，７０年代以后开展了颈椎管扩大成形术。我院１９８７年１１月～１９９３年１２月治疗的３...     

Hallucinations after preoperative baclofen discontinuation in spinal cord injury patients

Baclofen is a muscle relaxant approved in this country for the treatment of muscle spasms secondary to multiple sclerosis, spinal cord injury, and other spinal diseases. Although baclofen is considered to have fewer side effects than alternative drugs, problems can occur when the dosage is changed abruptly. Two patients are presented who developed hallucinations after discontinuing baclofen as part of routine preoperative procedures. Both patients responded at 23 and 31 hours after reinstituting baclofen. If possible, patients should be withdrawn slowly from baclofen before surgery. Any patient withdrawn abruptly from baclofen should be restarted as soon as possible.     

大鼠脊髓损伤后NEK6表达的实验研究

目的 探讨大鼠急性脊髓损伤后脊髓组织中NEK6的表达变化及意义.方法 采用改良Allen's打击法,构建大鼠脊髓T8-T10撞击伤模型,利用蛋白免疫印迹、免疫荧光双标的方法,研究大鼠脊髓损伤后脊髓组织中NEK6表达的时间和空间分布特征.结果 脊髓损伤后NEK6表达于撞击后2h有轻微抬高趋势,损伤后8h达到高峰,随后逐渐...     

半椎板与全椎板手术切除椎管内肿瘤对脊柱生物力学影响对比研究

目的观察半椎板与全椎板手术切除椎管内肿瘤对脊柱生物力学影响作用,以明确哪种方法对脊椎生物力学影响更少,术后恢复效果更佳。方法 128例椎管内肿瘤患者随机分成二组半椎板手术组65例,全椎板手术组为63例,均于手术后第2周进行脊柱生物力学检查,对比两组疗效。结果半椎板入路组术后脊柱生物力学功能较对照组强结论半椎板入路手术对脊柱功能损伤及术中出血少,患者适应性强,术后恢复也较快。     

小切口单侧半椎板切除入路治疗脊髓肿瘤的效果及安全性分析

目的：探讨小切口单侧半椎板切除入路治疗脊髓肿瘤的临床效果。方法选择2008年5月~2012年5月于本院就诊的44例脊髓肿瘤患者,简单随机分为试验组（22例）和对照组（22例）,试验组采用小切口单侧半椎板切除入路进行手术治疗,对照组采用传统的大切口全椎板切除入路进行手术治疗,观察两组的手术一般情况及治疗后神经功能恢复情况,比较两组的并发症发生率。结果治疗后试验组患者神经功能恢复为Ⅰ、Ⅱ级的比例显著高于对照组,神经功能恢复为Ⅲ、Ⅳ级的比例显著低于对照组,差异有统计学意义（P＜0.05）;试验组术中出血量少于对照组,下床时间、住院时间短于对照组,差异有统计学意义（P＜0.05）;试验组治疗后并发症发生率为13.6%,低于对照组的40.9%,差异有统计学意义（χ2=4.1250,P=0.0423）。结论小切口单侧半椎板切除入路治疗脊髓肿瘤效果显著,创伤较小,并发症少,安全性高,适合临床长期推广应用。     

Cardiovascular control after spinal cord injury

Spinal cord injury (SCI) leads to profound haemodynamic changes. Constant outflows from the central autonomic pattern generators modulate the activity of the spinal sympathetic neurons. Sudden loss of communication between these centers and the sympathetic neurons in the intermediolateral thoracic and lumbar spinal cord leads to spinal shock. After high SCI, experimental data demonstrated a brief hypertensive peak followed by bradycardia with escape arrhythmias and marked hypotension. Total peripheral resistance and cardiac output decrease, while central venous pressure remains unchanged. The initial hypertensive peak is thought to result from direct sympathetic stimulation during SCI and its presence is anaesthetic agent dependent. Hypotension improves within days in most animal species because of reasons not totally understood, which may include synaptic reorganization or hyper responsiveness of alpha receptors. No convincing data has demonstrated that the deafferented spinal cord can generate significant basal sympathetic activity. However, with the spinal shock resolution, the deafferented spinal cord (in lesions above T6) will generate life-threatening hypertensive bouts with compensatory bradycardia, known as autonomic hyperreflexia (AH) after stimuli such as pain or bladder/colonic distension. AH results from the lack of supraspinal control of the sympathetic neurons and altered neurotransmission (e.g. glutamatergic) within the spinal cord. Despite significant progress in recent years, further research is necessary to fully understand the spectrum of haemodynamic changes after SCI.     

Anterior cervical surgery methods for central cord syndrome without radiographic spinal fracture-dislocation

This study was aimed to explore the anterior cervical surgery methods to treat central cord syndrome without radiographic spinal fracture-dislocation (CCSWORFD), retrospectively analyze the cases of CCSWORFD, and evaluate the curative effect of anterior cervical surgery methods for CCSWORFD. Twenty four cases of CCSWORFD (19 males and 5 females), all suffering from cervical hyperextension injury, between 45–68 (average 59) years old, were operated on by anterior cervical surgery methods. Among these, 18 cases had been followed up for 6–24 (average 15) months; 18 cases, who had anterior decompression and plate fixation with titanium mesh bone grafting or iliac bone grafting achieved reliable effects based on the Japanese Orthopedics Association (JOA) evaluation (improved scores of cases with titanium mesh bone grafting, t = 2.800, P < 0.05; improved scores of cases with iliac bone grafting, t = 3.270, P < 0.05) and reliable reconstruction of cervical spine. The two groups obtained the same curative effect (t = 0.470, P > 0.05). Most of these cases had degeneration of cervical vertebra. The decompression which relieves the oppression to the spinal cord can help lessen edema of the spinal cord, and early fixation for stability of cervical vertebra is better for the recovery of spinal cord injury. Anterior operation with titanium mesh bone grafting or iliac bone grafting are both reliable curative methods for CCSWORFD, and titanium mesh bone grafting can avoid the trauma of the supplying graft. Mesh bone grafting can also shorten hospital stay.     

Neural plasticity after spinal cord injury

Spinal cord injury (SCI) has devastating physical and socioeconomical impact. However, some degree of functional recovery is frequently observed in patients after SCI. There is considerable evidence that functional plasticity occurs in cerebral cortical maps of the body, which may account for functional recovery after injury. Additionally, these plasticity changes also occur at multiple levels including the brainstem, spinal cord, and peripheral nervous system. Although the interaction of plasticity changes at each level has been less well studied, it is likely that changes in subcortical levels contribute to cortical reorganization. Since the permeability of the blood-brain barrier (BBB) is changed, SCI-induced factors, such as cytokines and growth factors, can be involved in the plasticity events, thus affecting the final functional recovery after SCI. The mechanism of plasticity probably differs depending on the time frame. The reorganization that is rapidly induced by acute injury is likely based on unmasking of latent synapses resulting from modulation of neurotransmitters, while the long-term changes after chronic injury involve changes of synaptic efficacy modulated by long-term potentiation and axonal regeneration and sprouting. The functional significance of neural plasticity after SCI remains unclear. It indicates that in some situations plasticity changes can result in functional improvement, while in other situations they may have harmful consequences. Thus, further understanding of the mechanisms of plasticity could lead to better ways of promoting useful reorganization and preventing undesirable consequences.     

颈前路手术治疗无骨折脱位脊髓中央损伤综合征

目的评价无骨折脱位脊髓中央损伤综合征（CCSWORFD）的颈前路手术治疗。方法回顾总结CCSWORFD资料,分析颈前路减压植骨钢板内固定治疗CCSWORFD疗效。结果重建颈椎稳定性可靠,依据JOA评分比较疗效显著。结论颈前路手术治疗CCSWORFD,采用钛网植骨与取髂骨植骨均可得到满意疗效。     

颈髓损伤后的低钠血症

目的探讨急性颈髓损伤后低钠血症的发病机制和治疗方法。方法回顾性分析2002年2月至2007年10月收治的13例颈髓损伤患者的临床资料。结果13例颈髓损伤患者中7例出现不同程度的低钠血症,均为FrankelA～B级患者。同期胸腰椎病变(骨折、结核等)所致脊髓损伤病例13例(按Frankel分级均为C～D级),无1例发生低钠血症。经高渗盐溶液补钠,适当补充胶体液1～2周后血钠水平恢复满意。结论低钠血症是急性颈髓损伤后常见的并发症,颈髓损伤程度越重,低钠血症发生率越高。其发生机制可能与颈髓损伤后交感神经系统受抑制,血管紧张素Ⅱ、醛固酮分泌减少有关。大量补钠、补液可纠正低钠血症,补充适当的胶体液有利于加快血钠水平的恢复。     

椎板减压钛网椎管成形后路融合内固定术治疗腰椎管狭窄症

目的:探讨椎板减压钛网椎管成形后路融合内固定术在腰椎管狭窄症中的临床应用效果.方法:选择32例退行性腰椎管狭窄症患者行椎板减压钛网椎管成形后路融合内固定术,测量术前、术后1年及术后最后1次随访时的腰椎管面积,同时记录患者主观对腰腿痛的Greenough和Fraser评分,进行统计学分析.结果:所有患者均获得随访,平均随访3.2(2.5～6)年.狭窄节段钛网椎管成形前横截面积为正常横截面积的(62.8±11.2)%,术后1年面积为(120.2±5.8)%,最后1次随访时为(123.6±9.2)%.术前Greenough和Fraser评分为(25.7±6.9)分,术后1年为(68.1±2.9)分,最后1次随访时为(68.7±8.7)分.椎管横截面积、Greenough和Fraser评分术后1年与术后最后1次随访时比较差异无显著性(P>0.05),但与术前比较差异均有显著性(P<0.01).结论:椎板减压钛网椎管成形后路融合内固定术治疗腰椎管狭窄症能够在恢复椎管形状、免除马尾及神经根压迫的同时,进行植骨融合,重建脊柱的稳定性,有利于保持手术疗效,值得临床推广应用.