发育性颈椎椎管狭窄症

发育性颈椎椎管狭窄症哈尔滨医科大学附属第二医院（１５００８６）邵林，潘海涛，王新婷，孙钟万发育性颈椎椎管狭窄症（简称ＤＳＣＳＣ）多见于中老年人，可引起颈髓损害。我院从１９９１年～１９９３年诊治２０例。临床资料本组２０例，男１４例，女６例；年龄３５～７...     

发育性颈椎椎管狭窄症

测量５０例颈椎骨干标本，确定男１１ｍｍ，女１０ｍｍ以下为狭窄椎管。１０具成人固定标本观察在最大伸、屈位时，脊髓变短，硬膜褶皱，间盘黄韧带截面矢径变小。统计病人１３例，占同期颈椎病性脊髓病的１８．６％；年龄超过５０岁者１０例，９例病程超过半年。首发症状为进行性下肢麻木无力，颈、胸平面以下不同程度痛觉减退，锥体束征阳性。Ｘ线平片测量、脊髓造影、ＣＴ或ＣＴＭ皆示椎管发育性狭窄。行椎板切除１例，后路椎板扩大成形１２例，除椎板切除１例远期效果欠佳外，余皆有明显改进。作者提出了本症的特征及诊断条件，认为确诊后以单开门椎管扩大成形、棘突骨支撑植骨术为佳。     

颈椎椎管发育性狭窄与脊髓型颈椎病

本文目的探讨脊髓型颈椎病与发育性椎管狭窄在临床发病的关系及其发病因素。报告９６例发育性颈椎管狭窄,发生脊髓型颈椎病。研究结果：发育性颈椎管狭窄是解剖学发育异常,退变后引起椎间盘变性,突出及骨赘形成,并造成脊髓或脊髓血管受压,以脊髓型颈椎病的形式发病。应用前入路直接切除致压物并行植骨融合术,如果椎管后方有致压物,可以有选择地二期施行后路减压。随访优良７５例。     

脊髓型颈椎病伴发育性椎管狭窄患者的脊髓储备空间

【摘要】 目的：观察脊髓型颈椎病伴发育性椎管狭窄患者颈椎MRI上脊髓在硬膜囊内的储备空间。方法：2006年2月~2010年7月,以脊髓型颈椎病就诊于北京大学第三医院骨科的患者123例,其中66例不伴后纵韧带或黄韧带骨化、椎体后缘骨赘或椎间盘突出的椎管侵占不超过50%的患者被纳入研究,其中男性41例,女性25例;年龄34~84岁,平均57岁。依据颈椎中立位X线平片上中矢径比值将所有患者分为伴发育性椎管狭窄组（狭窄组,中矢径比值≤0.75,n=38）和不伴发育性椎管狭窄组（非狭窄组,中矢径比值>0.75,n=28）,在MRI T2矢状位像上测量C3~C7硬膜囊中矢径和椎体中矢径,在MRI T2横断位像上测量脊髓横截面积和硬膜囊横截面积,计算并比较两组患者MRI中矢径比值（硬膜囊中矢径/椎体中矢径）和硬膜囊占有率（脊髓横截面积/硬膜囊横截面积）。结果：狭窄组C3~C7各节段MRI中矢径比值均显著小于非狭窄组（P<0.001）;C3~C6节段硬膜囊占有率与非狭窄组无显著性差异（P>0.05）,而C7节段有显著性差异（P<0.05）。结论：脊髓型颈椎病患者中,伴有发育性颈椎管狭窄的患者硬膜囊矢状径明显减小,但C3~C6节段脊髓在硬膜囊内的储备空间并未显著减小,呈现“小椎管小脊髓”的特点。     

发育性颈椎椎管狭窄症30例分析

发育性颈椎椎管狭窄症 (ｄｅｖｅｌｏｐ ｍｅｎｔａｌｓｔｅｎｏｓｉｓｏｆｃｅｒｖｉｃａｌｓｐｉｎａｌｃａｎａｌ,ＤＳＣＳＣ)多发于中老年人 ,可引起颈髓损害。随着影像学的发展 ,对本病的认识水平逐渐提高。我院从 1994年至 1999年诊治ＤＳＣＳＣ患者 30例 ,报告如下。临床资料　本组男 19例 ,女 11例 ,年龄 35～ 75岁 ,平均 45岁。发病因素 :颈部轻微外伤 7例 ,较重外伤 4例 ,无明显诱因 19例。发病时间 :最短 3ｄ ,最长5年。临床表现 :多数以双下肢麻木起病 ,病程缓慢 ,逐渐出现走路无力、不稳 ,似踩棉感 ,易摔倒。病变呈上行性发展 …     

发育性颈椎椎管狭窄合并颈椎病的诊断和治疗

本文报告发育性颈椎管狭管合并颈椎病并经手术治疗４５例。研究发现，颈椎病病变过程是颈椎椎管狭窄临床发病的常见原因。测量结果，颈３￣颈７椎管矢状径均在１０ｍｍ以下并有节段性椎体后缘增生和骨赘形成。根据临床神经系统检查和影像学重量象，分别选择颈椎前路和后路施行减压和植骨。平均随访１８个月，椎间融合率１００％，功能恢复优良率达８２．２％（３７／４５）。     

发育性颈椎椎管狭窄合并椎间盘突出症的治疗

作者报告发育性颈椎椎管狭窄合并椎间盘突出症２７例并经手术治疗。临床研究表明，颈椎间盘突出常在发育性颈椎椎管狭窄的病理基础上发生，并导致临床发病。根据影像学变化特点，对该病临床症状和体征与椎间盘突出的相关关系作了研究。选择性施行椎间盘切除和椎间植骨融合，获得良好效果。本组全部施行颈前路手术，平均随访１６个月，优良率为８８．９％（２４／２７）。     

发育性颈椎椎管狭窄合并颈椎病的诊断和治疗

本文报告发育性颈椎椎管狭管合并颈椎病并经手术治疗45例.研究发现,颈椎病病变过程是颈椎椎管狭窄临床发病的常见原因.测量结果,颈_3～颈_7椎管矢状径均在10mm以下并有节段性椎体后缘增生和骨赘形成.根据临床神经系统检查和影像学征象,分别选择颈椎前路和后路施行减压和植骨.平均随访18个月,椎间融合率100%,功能恢复优良率达82.2%(37/45).     

发育性颈椎管狭窄症

发育性椎管狭窄,可存于脊椎各节段,但临床上对腰椎注意的多,对发育性颈椎椎管狭窄,往往并入颈椎病中,专题讨论甚少。实际颈椎管狭窄之对脊髓损害,远较腰椎管狭窄之对马尾损害要重的多。由于此概念上的忽略或认识不足,致使对某些病情迟迟作不出诊断而延误治疗。对此我们近几年曾作了些实验及临床探讨,现将临床所遇病例,报告讨论如下,敬请指导。     

Physical characteristics of patients with developmental cervical spinal canal stenosis

There has been only one report on the physical characteristics of patients with developmental cervical spinal canal stenosis. The objective of this consecutive clinical study was to identify the physical characteristics of patients with developmental cervical spinal canal stenosis. The subjects were 243 patients with cervical spine disease who received treatment in our department between April 2001 and March 2002. These patients were divided into two groups (the groups of patients with and without spinal canal stenosis) on the basis of their lateral cervical spine radiographs. The six items examined were height, weight, sitting height, inter inner canthal distance, upper arm length, and head circumference in each patient, and then their values were compared between the two groups. The mean inter inner canthal distance was 2.7 cm in the group of patients with spinal canal stenosis and 3.5 cm in the group of patients without spinal canal stenosis; a significant difference (P < 0.01) was observed. Regarding height, weight, sitting height, upper arm length, and head circumference, no significant difference was found while comparing the two groups. In conclusion, developmental cervical spinal canal stenosis seems to be highly likely in patients with smaller inter inner canthal distance.     

发育性颈椎管狭窄合并脊髓型颈椎病的手术治疗

目的探讨发育性颈椎管狭窄合并颈椎病的安全、有效、合理的治疗方法.方法回顾性分析并对109例发育性颈椎管狭窄合并脊髓型颈椎病的治疗进行总结,其中采用Cloward环锯法手术20例,采用颈椎体次全切除治疗62例,采用单开门颈椎管扩大成形术27例.前路手术同期均采取自体髂骨植骨融合.结果 109例中95例获12～76个月的随访,平均随访36个月,优良率81.1%,改善率3.7%～84%,平均73.4%,无脊髓、神经根或椎动脉损伤等并发症的发生.结论对于发育性颈椎管狭窄合并脊髓型颈椎病前路、后路各种术式有着各自不同的适应证,选择合理的治疗手段十分重要.     

Relationship between developmental stenosis of cervical spinal canal and spinal cord injury]

A retrospective study of 55 patients with acute cervical spinal cord injury caused by trauma was performed. On radiographic examination of the cervical spine in each of 55 cases showed no fracture or dislocation but developmental stenosis determined on lateral view radiograms. Ninety five point nine percent of this cases had block of the dyeing columns myelographically both in prone and supine positions. Eighty point nine percent of 47 cases demonstrated segmental instability of the cervical spine on full extension and flexion radiograms. Thirty eight cases suffered a minor trauma but resulted in incomplete spinal cord injury with moderate neurologic deficits. Most patients who had been treated conservatively for about 3 years demonstrated the neurologic deficits worsened gradually. In the later 50 cases underwent surgical treatment. A follow-up study showed that Robinson's procedure and laminectomy resulted in unsatisfactory outcome, in contrast to those of open-door technic. It is suggested that developmental stenosis may be a potential factor in the spinal cord injury.     

The value of dynamic cervical MRI in management of selected patients presenting traumatic cervical cord injury

OBJECTIVE: The purpose of this report is to describe our experience with dynamic cervical MRI for detection of cervical spinal cord instability in patients presenting spinal cord trauma without fracture or dislocation of the spinal column. MATERIAL AND METHODS: Since January 2000 a total of 95 patients presenting spinal cord trauma have been treated in our department. All patients underwent MRI for diagnostic work-up. Dynamic MRI was performed if spinal cord instability was suspected. Whenever possible, high-quality plain radiography dynamic views were obtained (coma, severe deficit, study of the cervicothoracic junction). RESULTS: Dynamic MRI allowed diagnosis of spinal cord instability in 6 patients with a mean age of 65 years (range, 45 to 75). Instability occurred during extension in 4 patients and during flexion and extension in one case. In the remaining case instability was associated with herniation of a cervical disc due to a severe cervical sprain. All 6 patients underwent early surgical stabilization that allowed improvement in-hospital patient care and quick transfer to rehabilitation centers. CONCLUSION: Dynamic MRI can be a useful tool to detect unstable spinal cord instability in some patients presenting noncompressive spinal cord injuries.     

甲基强的松龙在发育性颈椎管狭窄合并脊髓型颈椎病围手术期的应用

目的探讨围手术期预防性应用甲基强的松龙(MP)对发育性颈椎管狭窄(DCS)合并脊髓型颈椎病(CSM)患者脊髓减压术后神经功能恢复的影响.方法62例DCS合并CSM患者,根据围手术期是否应用MP分为2组,MP组32例,术中脊髓减压前30min以MP 30mg/kg静滴(15min内滴完),45min后继以5.4mg/kg/h维持用药23h;对照组30例,术中脊髓减压前给予地塞米松15mg静脉点滴,术后地塞米松10mg静滴×3d.术后3d、7d、1个月、6个月和12个月按JOA评分标准评定两组患者的神经功能改善率[(术后JOA评分-术前JOA评分)/(17-术前JOA评分)×100%],观察统计并发症.结果术后3d两组患者神经功能改善率比较无显著性差异(P＞0.05),术后7d时MP组与对照组神经功能改善率分别为(68.43±9.89)%、(49.67±11.45)%,有显著性差异(P＜0.05),术后1个月时分别为(77.32±11.24)%、(61.65±10.42)%(P＞0.05),术后6个月时分别为(81.12±10.42)%、(70.45±9.22)%(P＜0.05),术后12个月时分别为(83.15±8.57)%、(81.77±11.61)%(P＞0.05).术后对照组有4例出现肩痛,MP组无严重并发症出现.结论DCS合并CSM患者围手术期预防性应用MP能提高手术的安全性及术后近期神经功能改善率,未增加严重不良反应的发生.     

The disposition of the cervical spine and deformation of available cord space with conventional- and balloon laryngoscopy-guided laryngeal intubation: a comparative study

Orotracheal intubation causes cervical spine (C-spine) extension and potential (hypothetical) space available for the cord (SAC)-deformation. In the present study, we determined and compared the changes induced by conventional- and balloon laryngoscopy-guided orolaryngeal intubation in the upper C-spine's osseous unit-orientation, segmental angulation, segmental SAC-sagittal surface areas (SSAs), segmental/total posterior SAC-aspect, and segmental SAC-width. Eight healthy volunteers were enrolled. A set of neutral head position (baseline)- and two sets of intubation-lateral C-spine radiographs were obtained. Relative to baseline, both intubation techniques induced significant changes in the occiput (OCC)-, third cervical vertebra (C3)-, C4-, and C5-orientation, the OCC-C1-segmental angulation, all the segmental SAC-SSAs, and the OCC-C1-, and C1-2-posterior SAC-aspect (P < 0.05 to < 0.001); conventional intubation caused additional significant changes in C2-orientation, total (OCC through C5)-posterior SAC-aspect, and OCC-C1-SAC-width (P < 0.05 to < 0.001). Relative to conventional intubation, balloon-assisted intubation caused less change in C3-orientation and C2-3-SAC-width (P < 0.05), and less reduction in OCC-C1-, C1-2-, and C4-5-SAC-SSAs (P < 0.05 to < 0.01). Orotracheal intubation should be cautiously performed in patients with space-occupying upper-C-spine-SAC lesions, even if there is no concomitant osseous/ligamentous pathology. In such cases, balloon laryngoscopy may be chosen over the conventional technique, because it causes less SAC deformation. IMPLICATIONS: This study shows that direct laryngoscopy-guided orotracheal intubation causes deformation of the upper cervical space available for the cord, even in the absence of cervical spine instability. These effects are attenuated with balloon laryngoscopy, and thus, its use is recommended in patients with space-occupying lesions within the spinal canal.