Diagnosis and treatment of penetrating anorectal wounds

Penetratingwoundofanalcanalisrelativelyrareinclinic.Concomitantinjuriesofrectum,urinarybladderorposteriorurethraareoftenpresent.Misseddiagnosisorimpropertreatmentcancause complicationssuchaspelvicabscess,analstenosis,fecalincontinenceandrecto vesicalfistula.Sixteen casesofpenetratinganotectalwoundsweretreatedin ourhospitalfrom1985to2004.Goodresultswere obtained.Thedetailsaredescribedinthisarticle.METHODS GeneraldataTherewere16malepatientsof penetratinganorectalwounds,aged1852years(average3…     

Surgical management of penetrating pelvic trauma: a case report and literature review

High-velocity penetrating pelvic injury is one of the most difficult challenges to trauma surgeons. The injury sites frequently include soft tissue, pelvis, genitourinary tract, vascular structures and intraabdominal viscera. We present an unusual case of a male patient suffering a collision at night with a deformed steel bar penetrating into his right groin. Careful planning of the surgical approach is important before extracting the foreign body. The possibility of multiorgan damage to intrapelvic structures such as colon, urinary bladder, vessels and nerves, frequently necessitates a multidisciplinary involvement and systematic approach. Besides, limited incision as well as modification should be considered, and debridement and perioperative antibiotics can be used to reduce the risk of serious wound infection.     

椎管环形减压椎弓根螺钉固定治疗胸腰椎骨折并脊髓损伤32例

1993-2001年采用后路椎管环形减压椎弓根螺钉短节段固定治疗胸腰椎骨折并脊髓马尾损伤32例,取得了较满意的效果.……     

后路椎板切除、钉棒系统内固定治疗上颈椎椎管内肿瘤

目的 探讨后路椎板切除、钉棒系统内固定及自体髂骨植骨融合术治疗上颈椎椎管内肿瘤的方法及疗效.方法 2003年1月至2008年6月,共收治上颈椎椎管内肿瘤患者16例,男10例,女6例;年龄33～68岁,平均44.7岁.硬膜外肿瘤2例,硬脊膜下脊髓外肿瘤13例,髓内肿瘤1例.肿瘤位于延髓～C1,3例,C1,28例,C2水平2例,C1-3 2例,C2,31例;其中4例肿瘤位于颈髓腹侧.15例患者行CT或MR检查示肿瘤组织压迫脊髓.Frankel分级:C级5例,D级10例,E级1例.采用后路椎板切除肿瘤,同时行钉棒系统内固定及自体髂骨植骨融合术.结果 所有患者术后均获得随访,随访时间6～58个月,平均27.4个月.根据JOA 17分法评分,术前6～17分,平均8.8分;术后6个月14～17分,平均16分,平均改善率88.1%.术后影像学检查示植骨融合良好.Frankel分级:7例由术前的D级恢复至E级,5例由C级恢复至D级,3例D级及1例E级的患者术后未改变.结论 后路椎板切除肿瘤、钉棒系统内固定及植骨融合治疗上颈椎椎管内肿瘤,可彻底切除肿瘤病灶,解除颈脊髓及神经根压迫,重建上颈椎的稳定.     

骶管注射对无坐骨神经痛性腰椎间盘突出症的疗效分析

目的：观察骶管注射疗法对无坐骨神经痛性腰椎间盘突出症患者的疗效。方法：2010年12月至2011年6月,对就诊的65例经CT或MRI检查证实为腰椎间盘突出或膨出所致的急性腰痛且无下肢放射痛的患者随机分为骶管注射组（试验组）和腰椎斜扳组（对照组）,试验组35例,男30例,女5例,年龄3356岁,平均（43．90±1．14）岁;对照组30例,男27例,女3例,年龄3457岁,平均（44．00±1．19）岁。两组的发病时间为1 h～3 d。分别行骶管注射或腰椎斜扳手法治疗。比较治疗前和治疗后30 min两组的VAS评分。结果：所有患者经治疗后急性腰痛症状明显缓解,骶管注射组和腰椎斜扳组的VAS评分分别从（6．63±0．97）和（6．67±0．96）分减至（3．06±1．51）和（3．93±1．20）分,两种治疗方法均能改善患者VAS评分,但骶管注射组治疗要优于腰椎斜板组（P 0．05）。结论：骶管注射和腰椎斜扳疗法对无坐骨神经痛性腰椎间盘突出症急性腰痛的患者具有快速缓解的作用,且前者的疗效更佳。     

椎管内蛛网膜囊肿临床表现及其手术方式

目的:分析椎管内蛛网膜囊肿的临床表现、手术方式及其治疗效果,为椎管内蛛网膜囊肿诊断和手术治疗方案的合理选择提供依据.方法:回顾分析21例椎管内蛛网膜囊肿临床表现、手术方式及术后效果,男9例,女12例;年龄21～55岁,平均36.15岁;病程2个月～3年,平均6.2个月.21例椎管内蛛网膜囊肿中1例发生于颈段、1例发生于胸段、19例发生于骶部,表现为受累神经支配区的放射性疼痛、感觉异常、功能障碍.16例经CT结合椎管造影明确诊断,其余通过MRI明确诊断.8例采用囊肿切除、囊颈部结扎、硬膜重叠紧缩缝合手术;11例囊肿壁与神经难以分离,采用囊肿壁部分切除、交通口肌肉堵塞、硬膜紧缩缝合手术;2例串珠状囊肿,其交通口未能找到,采用囊肿开窗引流、囊壁部分切除、硬膜重叠紧缩缝合、游离肌肉压迫固定.结果:19例患者获得随访,随访时间2个月～5年3个月,平均21.2个月.囊肿切除、囊颈部结扎手术组的优良为6例,囊肿壁部分切除、交通口肌肉堵塞组的优良为8例.结论:椎管内蛛网膜囊肿是蛛网膜的先天性畸形,以骶部椎管好发,大多数临床表现为受累神经的功能异常;具有手术指征的病例,术中应根据囊肿开口、囊肿壁是否能与神经分离等情况选择不同的囊肿处理方法.     

患椎间短椎弓根螺钉在单节段腰骶椎结核稳定性重建中的临床研究

目的证明后路患椎间短椎弓根螺钉固定治疗单节段腰骶椎结核的可行性,并探讨其适应证及疗效。方法 204例诊断明确、脊柱后凸畸形35°,符合纳入标准的单节段腰、骶椎结核患者,随机分为2组,均先进行后路矫形、内固定手术,同期或二期进行前路彻底病灶清除、椎体间自体髂骨支撑植骨融合术。其中短钉组104例,选用长20~35 mm的短椎弓根钉置于患椎椎弓根。如1个患椎剩余骨质1/3,而另1个患椎剩余骨质1/3,则行短钉、常规螺钉固定。长钉组:常规椎弓根螺钉置于患椎相邻的正常椎骨中,固定范围跨越患椎上、下各1个正常间隙。所有患者均采用四联化疗方案。结果 2组患者平均随访62.1个月。术后均无严重并发症发生,末次随访时,所有患者均治愈,无内固定松动及断裂现象。植骨平均愈合时间,短钉组4.3个月,长钉组4.6个月,Cobb角矫正度及丢失率2组分别为13.26°±3.76°,6.22%和16.35°±2.63°,5.24%,2组比较差异无统计学意义(P0.05),组内术前术后比较差异有统计学意义(P0.05)。血沉与C反应蛋白的术前术后差异无统计学意义。2组患者术后2年生活、工作基本恢复正常。短钉组患者术后功能恢复较长钉组好。结论腰、骶椎结核后路患椎间短椎弓根钉固定、前路病灶彻底清除术具有仅融合、固定病变节段,保留相邻正常的脊柱运动单元功能,术后脊柱功能恢复好等优点,具有很高的临床应用价值。     

椎管原发性肿瘤致截瘫临床特点与外科治疗效果分析

目的 探索椎管原发性肿瘤致截瘫原因,分析采用显微外科技术摘除肿瘤疗效。方法对23例原发性椎管肿瘤致截瘫病例进行治疗,对其致瘫的原因、临床特点、影像学改变进行分析。结果 经术后3～26个月随访,依据美国脊柱损伤学会对Frankel脊髓损伤修订分级标准评定:除2例术后截瘫无改善外,其它21例瘫痪基本恢复。结论 详细的病史收集、系统的物理检查、高质量影像检查与分析,是早期诊断的关键;避免盲目性推拿、按摩、牵引是预防突发性截瘫或截瘫加重的重要环节;显微外科技术切除肿瘤,具有解剖层次分明,肿瘤切除彻底,对脊髓、神经根干扰小的优点,其疗效更令人满意。     

细胞穿透肽PEP-1介导血红素加氧酶-1对大鼠肠缺血再灌注损伤的影响

目的 评价细胞穿透肽PEP-1介导血红素加氧酶-1(HO-1)对大鼠肠缺血再灌注损伤的影响.方法 雄性SD大鼠18只,周龄7～9周,体重210～260 g,采用随机数字表法,将大鼠随机分为3组(n=6):假手术组(S组)、肠缺血再灌注组(IR组)和融合蛋白PEP-1/HO-1+肠缺血再灌注组(HO组).采用夹闭肠系膜上动脉45 min,恢复灌注120 min的方法制备大鼠肠缺血再灌注损伤模型.HO组夹闭肠系膜上动脉前30 min,左侧髂静脉注射融合蛋白PEP-1/HO-1 0.5 mg,S组不夹闭肠系膜上动脉,余操作同IR组.于再灌注120 min时处死大鼠取小肠组织,称重后计算肠湿/干重比,测定丙二醛(MDA)含量、超氧化物歧化酶(SOD)活性和HO-1活性,免疫组化法检测肠组织HO-1蛋白的表达,光镜下观察肠组织结构并进行损伤评分.结果 与S组比较,IR组和HO组肠湿/干重比和MDA含量升高,SOD活性降低,HO-1活性和蛋白表达水平升高,损伤评分升高(P＜0.05);与IR组比较,HO组肠湿/干重比、MDA含量降低,SOD活性升高,HO-1活性和蛋白表达水平升高,损伤评分降低(P＜0.05).HO组大鼠肠组织病理学损伤较IR组减轻.结论 细胞穿透肽PEP-1可将HO-1成功导人大鼠肠组织中的细胞并减轻肠缺血再灌注损伤.

Abstract：

Objective To investigate the effects of heme oxygenase-1 (HO-1) mediated by cell penetrating peptide PEP-1 on intestinal ischemia/reperfusion (I/R) injuiy in tats. Methods Eighteen male SD rats aged 7-9 weeks weighing 210-260 g were randomly divided into 3 groups (re = 6 each): sham operation group (group S) , I/R group and PEP-1/HO-1 + I/R group (group HO) . To establish a model of intestinal I/R injury, intestines were exteriorized and the superior mesenteric artery was exposed and occluded for 45 min ischemia, and then the clamp was removed for 120 min reperfusion. The PEP-1/HO-1 fusion protein 0.5 mg was injected via the left iliac vein 30 min prior to ischemia in group HO. The superior mesenteric artery was exposed but not occluded in group S. At the end of reperfusion, the rats were sacrificed and intestinal tissues obtained to determine the intestinal wet/ dry ratio, malondialdehyde (MDA) level, activities of superoxide dismutase (SOD) and HO-1, and HO-1 protein expression. The histological changes in the intestinal mucosa were examined and the injuiy was scored. Results Compared with group S, the intestinal wet/dry ratio, MDA level, HO-1 activity, HO-1 protein expression and injury score were significantly increased, while the SOD activity was significantly decreased in groups I/R and HO ( P ＜ 0.05) . Compared with group I/R, the intestinal wet/dry ratio, MDA level and injury score were significantly decreased, while the SOD activity, HO-1 activity and HO-1 protein expression increased in group HO ( P ＜ 0.05) . The pathologic changes were significantly attenuated in group HO compared with group I/R.Conclusion HO-1 protein can be successfully delivered into intestinal tissues by PEP-1 and has protective effects against intestinal I/R injury.     

细胞穿透肽PEP-1介导的血红素加氧酶-1对大鼠肠缺血再灌注诱发肝损伤的影响

目的 评价细胞穿透肽PEP-1介导的血红素加氧酶-1(HO-1)对大鼠肠缺血再灌注诱发肝损伤的影响.方法 雄性SD大鼠24只,7～9周龄,体重210～260 g,采用随机数字表法,将其分为3组(n=8):假手术组(S组)、肠缺血再灌注组(I/R组)和融合蛋白PEP-1/HO-1组(HO组).采用夹闭肠系膜上动脉45 min,恢复灌注120 min的方法制备大鼠肠缺血再灌注模型.HO组于缺血前30 min经左侧髂静脉注射融合蛋白PEP-1/HO-1 0.5 mg,S组仅分离闭肠系膜上动脉,但不夹闭.于再灌注120 min时,右侧颈总动脉取血样,测定血清AST和ALT的活性;然后处死大鼠,取肝组织,光镜下观察病理学结果,测定MDA含量和SOD活性.结果 与S组比较,I/R组和HO组血清AST和ALT的活性升高,肝组织MDA含量升高,SOD活性降低(P＜0.05);与I/R组比较,HO组血清AST和ALT的活性降低,肝组织MDA含量降低,SOD活性升高(P＜0.05),肝损伤减轻.结论 细胞穿透肽PEP-1介导的HO-1可减轻大鼠肠缺血再灌注诱发的肝损伤.     

坠落伤致胸腰椎Chance骨折的诊断与外科治疗

目的 探讨坠落伤致胸腰椎Chance骨折的诊断及短节段椎弓根螺钉系统治疗的疗效.方法 回顾性分析2000年1月至2007年1月收治的由高处坠落伤所致16例Chance骨折患者的临床资料.所有患者均接受短节段椎弓根螺钉系统内固定治疗,术后通过影像学检查和Oswestry功能障碍指数综合评价其疗效.结果 1例合并踝关节开放脱位与颅脑损伤,3例合并跟骨骨折,1例合并肾挫伤.无手术并发症.随访7个月～6年,平均2.6年.伤椎前缘高度由术前平均(63.3±6.8)%恢复至术后(92.1±4.0)%(P<0.01),随访时为(90.7±3.6)%,与术后相比差异无统计学意义(P>0.05).随访时患者Oswestry功能障碍指数平均为4.9.结论 高处坠落伤所致胸腰椎Chance骨折的合并伤及损伤机制不同于安全带型Chance骨折.短节段椎弓根螺钉系统内固定治疗Chance骨折疗效满意.     

通道下肌间隙入路腰椎固定融合术并发神经损伤的原因及预防

目的总结通道下肌间隙入路腰椎固定融合术并发神经损伤的特点,分析损伤原因并提出预防措施。方法武警浙江省总队医院2012年6月—2015年12月由同一组医师采用通道下肌间隙入路固定融合术治疗的腰椎病变患者277例,其中9例出现神经损伤(男4例、女5例),年龄42~78岁,平均56.7岁。腰丛损伤1例,马尾神经损伤1例,神经根损伤7例。手术操作损伤3例,螺钉位置不正确损伤2例,血肿压迫2例,混合因素1例,原因不明1例。予非手术治疗5例,再次手术4例。结果 9例患者随访9~36个月,平均22.5个月。末次随访时,手术操作直接损伤的3例中2例部分恢复,1例完全恢复;2例椎弓根螺钉位置不正确所致的神经根损伤完全恢复;2例血肿压迫所致神经损伤者1例完全恢复,另1例大部分恢复;混合因素导致马尾神经损伤的1例患者部分恢复;损伤原因不明的1例完全恢复。结论通道下肌间隙入路腰椎固定融合术的神经并发症以神经根损伤多见。神经损伤有显露和手术方式的客观原因,但术者的操作可能是更主要的因素。术前应严格选择病例、术中操作要谨慎细致,以预防神经损伤的发生。     

Ethnic differences in pedicle and bony spinal canal dimensions calculated from computed tomography of the cervical spine: a review of the English-language literature

Purpose

The aims of this study were to review published data on pedicle dimensions and bony spinal canal diameters calculated from CT examinations of the cervical spine through the English-language literature and analyze these data for ethnic disparities and similarities.

Materials and methods

The authors reviewed the literature on “pedicle” and “spinal canal” by conducting a bibliographic search using PubMed, Ovid MEDLINE, and Science Direct from January 1985 to December 2010. After evaluating all of the selected abstracts, we ultimately selected 19 studies involving living subjects: 12 studies on pedicle dimensions and 7 on spinal canal diameters. The four parameters, pedicle width (PW), pedicle transverse angle (PTA), anterior-posterior diameter of the spinal canal (APD), and transverse diameter of the spinal canal (TD), were analyzed at the relevant levels from C3 to C7. In addition, the values for pedicle dimensions and spinal canal diameters in the European/American populations were compared using the data from Asian populations as a baseline.

Results

The smallest mean PW was found at C4 in the male (5.1 mm) and female populations (4.1 mm); the largest mean PW was found at C7 in both male (7.7 mm) and female populations (7 mm). The PW in males was greater than in females at the majority of levels. The smallest mean PTA was found at C7 in both male (33.4°) and female populations (33°); the largest mean PTA was found at C4 in both male (53.2°) and female populations (52.1°). The overall PW, PTA, APD, and TD ratio of European/American to Asian populations was 91.4–98.8, 99.6–106.2, 110.7–122, and 100–108.3 %, respectively.

Conclusion

Although our cervical spine CT data were suggestive of possible ethnic differences in spinal canal morphology, our analysis failed to identify significant ethnic disparity in pedicle dimensions despite potential differences in physique between populations.     

Diagnostic dilemma of sacral abscess presented with seizure and altered conscious level in a patient with spinal cord injury

Context: Infection and septicaemia may clinically presented with seizure and altered conscious level. In spinal cord injury (SCI) population, they are at risk of having pressure ulcer which can be complicated further with infection and septicaemia.

Findings: A 40-year-old man with complete T4 SCI and multiple clean and non-healing pressure ulcers at sacral and bilateral ischial tuberosity regions was initially admitted for negative pressure wound therapy (NPWT) dressing. He had an episode of seizure and subsequently had fluctuating altered conscious level before the diagnosis of deep-seated sacral abscess was made and managed. Prior investigations to rule out common possible sources of infections and management did not resolve the fluctuating event of altered consciousness.

Clinical relevance: We presented an unusual case presentation of septicemia in a patient with SCI with underlying chronic non-healing pressure ulcer. He presented with seizure and fluctuating altered conscious level. Even though a chronic non-healing ulcer appeared clinically clean, a high index of suspicion for deep seated abscess is warranted as one of the possible sources of infection, especially when treatment for other common sources of infections fails to result in clinical improvement.     

Emergency decompression and stabilization of 1st thoracic spinal cord injury and sacral fracture in a Covid-19 patient: A case report

Introduction and importanceSpinal cord injury is mostly caused by traumatic accident and usually associated with several injuries. The ideal treatment of orthopaedic injury is to perform surgical decompression and stabilization early.Case presentationA 24-year-old-male patient came in emergency department with history of severe pain in his thoracic vertebrae after fell from 10 m height. His buttock was hit the ground first and patient was alert. He felt hypoesthesia below the injured level and dysfunctional motor and sensory of both lower extremities. We put pedicle screw at the C7, Th1, Th2 and Th 3. Then we put rods and nuts. After that, we did decompression by laminectomy of the C7 and Th1 and we put vacuumed drain for the wound.Clinical discussionThis patient was diagnosed with traumatic spinal cord injury of 1st thoracic vertebra ASIA Impairment Scale (AIS) C and sacral fracture Denis classification zone II of right side with confirmed Covid-19 case. First patient treated with 1000 mg methyl prednisolone. An early surgical treatment was open reduction and internal fixation (ORIF) sacral fracture. We put a two-hole 4.5 narrow dynamic compression plate (DCP) at the lateral side of posterior ridge of iliac bone, between posterior superior iliac spine (PSIS) and posterior inferior iliac spine (PIIS).ConclusionImmediate surgical decompression and stabilization for spinal cord injury give significant improvement in motor and sensory function. Appropriate management for Covid-19 patient with Favipiravir and some supplements, had been proved control the virus and give patient good quality of life.     

屈伸位颈椎MR扫描对颈椎管狭窄程度的研究

目的：研究颈椎管狭窄者在颈椎屈伸位下椎管狭窄程度的变化。方法：30例颈椎管狭窄,男13例,女17例;年龄28～66岁,平均39岁。颈椎椎管矢状径10mm以下即绝对狭窄者12例,颈椎椎管矢状径10～12mm即相对狭窄者18例．均行中立、前屈、后伸位MR扫描,获取MR图像后评价颈椎管的狭窄程度和颈髓受压情况的变化,结果：颈椎管狭窄者在后伸位上出现颈椎管狭窄加重19例,较前屈位8例明显多（P〈0．05）。结论：对于颈椎管狭窄的影像学诊断,屈伸位颈椎MR扫描可较好地补充常规中立位MR检查,而且后伸位MR较中立位和前屈位更具敏感性     

Staggered rhizotomy of anterior and posterior sacral roots for bladder reservoir function in spinal cord injury: a canine experimental study and preliminary clinical report

Objective: To report an experimental study and preliminary clinical results of staggered anterior and posterior sacral rhizotomy for restoring function of the bladder and preventing reflex incontinence in supra‐conal spinal cord injury (SCI). Methods: Ten T10 spinal cord transected mongrel dogs were divided into three groups. In group 1 (n= 2), laminectomy only was performed (control). In group 2 (n= 4), all L7‐S3 posterior roots were microsurgically cut (complete deafferentation). And in group 3 (n= 4), the L7, S1, S3 posterior roots and S2 anterior root were cut (staggered deafferentation and deefferentation). Intraoperative electrical stimulation and postoperative cystometrography (CMG) were carried out. In the clinic, three patients with spastic bladder caused by a supra conal complete SCI underwent staggered rhizotomy and were followed up for 6 years. Results: In the canine experimental study, resection of the S2 anterior root combined with L7, S1 and S3 posterior rhizotomy, stimulating the S2 posterior root (four dogs) resulted in a minimal rise in pressure in the bladder and urethra, which was only about 10% of that obtained by stimulating the S2 proximal posterior root while its anterior counterpart was intact (eight dogs, Student's t‐test, P < 0.01). The CMG study showed that groups 2 and 3 had similar volume/pressure curves; in both groups the tendency was to develop flaccid bladders. In the clinic, three cases underwent staggered rhizotomy of the anterior and posterior roots in S3 and S4. Good bladder reservoir and compliance was achieved over six years of follow‐up. Conclusion: Staggered rhizotomy of the anterior and posterior sacral roots at different spinal cord levels has the same denervation effect as a complete posterior rhizotomy, and good bladder reservoir function can be achieved by this procedure.     

“天玑”骨科手术机器人辅助与徒手穿刺椎体成形术治疗上胸椎骨质疏松性椎体压缩骨折的疗效比较

目的比较"天玑"骨科手术机器人辅助和徒手穿刺椎体成形术治疗上胸椎骨质疏松性椎体压缩骨折(OVCF)的疗效。方法回顾性分析西安交通大学医学院附属红会医院脊柱外科自2018年1月至2019年3月使用"天玑"骨科手术机器人辅助下穿刺完成椎体成形术的19例上胸椎OVCF患者(20个椎体)资料(机器人组)和自2016年1月至2017年12月徒手穿刺完成椎体成形术的21例上胸椎OVCF患者(21个椎体)资料(徒手组)。机器人组男5例,女14例;年龄62~88岁;徒手组男6例,女15例;年龄64~83岁。通过比较两组患者的手术时间、骨水泥注入量、术后并发症(骨水泥渗漏、感染和血管栓塞),术后1 d、末次随访时的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、伤椎椎体前缘高度(AH)和伤椎后凸角(KA)观察疗效。结果机器人组和徒手组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。机器人组中19例患者(20个椎体)和徒手组中21例患者(21个椎体)均顺利完成单侧穿刺入路椎体成形术。40例患者术后随访6~12个月,平均8.3个月。机器人组的手术时间[(37.9±8.2)min]、骨水泥注入量[(2.3±0.9)mL]、骨水泥渗漏发生率(10.0%,2/20)均少于或低于徒手组[(46.2±9.4)min、(4.2±1.3)mL、42.9%(9/21)],差异有统计学意义(P<0.05)。两组患者均无感染和血管栓塞发生。术后1 d、末次随访时两组间VAS评分、ODI、AH和KA比较差异均无统计学意义(P>0.05)。结论相比于传统徒手穿刺椎体成形术,"天玑"骨科手术机器人辅助下穿刺完成椎体成形术治疗上胸椎(T1~T4)OVCF临床疗效满意,可减少手术时间和骨水泥注入量,并降低骨水泥渗漏的发生率。     

Pavlov's Ratio of the Cervical Spine in a Korean Population: A Comparative Study by Age in Patients with Minor Trauma without Neurologic Symptoms

BackgroudThere are many studies on the vertebral body-to-canal ratio, the so-called Pavlov''s ratio of the cervical spine. However, there are no studies on its relation with age to clarify each bony component''s contribution to the spinal canal formation and its size. The aim of this study was to investigate differences and changes in the vertebral body-to-canal ratio according to age in an asymptomatic population.MethodsThis is a cross-sectional study of 280 asymptomatic individuals. A total of 140 men and 140 women representing each decade of life from the first to the seventh were included in this study. The anteroposterior length of the vertebral body and canal from C3 to C6 was measured on sagittal radiographs to calculate the vertebral body-to-canal ratio.ResultsThe average Pavlov''s ratio was significantly larger (p < 0.001) in the first decade of life. The average Pavlov''s ratio of the individuals in the first decade of life was 1.09 between C3 and C6 (1.08 at C3, 1.07 at C4, 1.11 at C5, and 1.13 at C6; range, 0.78–1.51). There was no significant difference among the other decades of life.ConclusionsWe assessed the Pavlov''s ratio of the cervical spine in an asymptomatic population. It is our belief that the spinal canal size is the largest in the first decade of life, and the Pavlov''s ratio becomes almost fixed throughout life after maturity.     

大鼠脊髓腹侧左迫损伤后神经营养素及受体表达的变化规律

目的：探讨脊髓损伤后脊髓功能恢复的分子生物学基础。方法：在制作脊髓腹侧压迫损伤的基础上,应用免疫组织化学的方法观察几种神经营养素及其受体表达的变化规律。结果：脊髓腹侧压迫损伤后BDNF,GNDF,NT3,NGF以及TrkA,TrkB,TrkC在伤后3h表达开始增加,伤后72h达到高峰,在伤后2周内其表达维持在相对较高的水平,且以BDNF及TrkB表达最明显。结论：脊髓损伤后这些内源性神经营养素及其受体的大量表达对受损伤脊髓的功能恢复起重要作用。同时也反映了受试动物的脊髓功能受损较重的特点。