经后路寰椎侧块螺钉、枢椎椎弓根螺钉内固定的临床应用

目的:探讨寰椎侧块螺钉、枢椎椎弓根螺钉内固定的临床应用.方法:应用寰椎侧块螺钉14枚,枢椎椎弓根螺钉20枚及连接板或棒稳定上颈椎10例,回顾性分析临床疗效,手术设计和并发症的预防.结果:进钉点显露过程中出现静脉丛出血3例,两例两处寰椎后弓下壁破裂,改为经寰椎后弓下置钉,无椎动脉损伤、感染、脑脊液漏,全部病例随访3个月～3 a,平均1.4 a,无内固定松动,骨折不愈合.结论:寰椎侧块螺钉,枢椎椎弓根螺钉及连接板或棒固定技术稳定上颈椎具有肯定的三维固定效果,操作简便,固定可靠,只要正确掌握适应症,术前以三维CT为基础进行科学设计,术中仔细操作,大多数并发症可避免,安全可靠.     

个体化设计解剖定位椎弓根镙钉置入内固定治疗寰枢椎不稳

背景：经寰枢椎椎弓根螺钉置入内固定常用于治疗寰枢椎不稳。但是,目前寰枢椎椎弓根螺钉的进钉点和进钉角度多以统计处理的解剖数据确定,解剖差异的存在使目前置钉方法难以保证椎弓根螺钉准确置入到每一例患者。 目的：评估个体化设计解剖定位寰枢椎椎弓根螺钉置入内固定技术治疗寰枢椎不稳的安全性和可靠性。 方法：对16例寰枢椎不稳患者分别以术中寰椎椎弓根下壁、内侧壁以及枢椎上壁、内侧壁为定位依据,结合置入前影像学测量确定寰、枢椎椎弓根镙钉的进钉点、进钉角度以及镙钉长度,置入寰、枢椎椎弓根螺钉内固定系统。 结果与结论：16例患者均成功置入螺钉,置入后X射线片及CT显示寰枢椎椎弓根螺钉位置良好。置入后随访9~24个月,所有患者均获得骨性融合、症状改善,置入后脊髓功能改善优良率为84.6%,其中优6例(46.2%),良5例(38.5%),可2例(15.4%),无神经血管损伤等并发症发生。提示个体化设计解剖定位寰枢椎椎弓根螺钉置入内固定治疗寰枢椎不稳的进钉点和进钉角度定位准确,螺钉置入安全、可靠。 关键词：寰枢椎不稳;椎弓根螺钉;个体化设计;解剖定位;植入体 doi:10.3969/j.issn.1673-8225.2012.09.026      

经口咽前路寰枢椎复位钢板螺钉固定强度的生物力学评价

目的对经口咽前路寰枢椎复位内固定钢板(transoralpharyngeal atlantoaxial reduction plate,TARP)进行固定螺钉拔出力实验,评估TARP系统枢椎前路椎弓根和关节突下螺钉固定的生物力学强度。方法 6例C1、C2椎体新鲜标本左右双侧均行螺钉固定,寰椎螺钉固定于侧块,枢椎螺钉分别采用椎体、前路椎弓根及关节突下固定,在生物力学实验机上通过传感器测定TARP系统寰椎和枢椎固定螺钉的最大拔出力、钉道长度,并进行统计学分析。结果寰椎(546.45±85.07)N与枢椎前路椎弓根螺钉(593.14±97.77)N的最大拔出力之间无显著性差异,枢椎前路椎弓根螺钉拔出力明显强于枢椎椎体和关节突下螺钉,枢椎关节突下螺钉(469.94±73.32)N拔出力明显强于枢椎椎体螺钉(395.15±75.07)N。结论 TARP系统枢椎螺钉固定采用前路椎弓根及关节突下固定优于枢椎椎体固定,固定安全可靠。     

寰椎椎弓根解剖和CT测量在椎弓根螺钉固定中的意义

目的：确定寰椎后路椎弓根钉的进钉点和验证螺钉在寰椎侧块中的位置。方法：用40副干燥寰枢椎标本测量进钉点的最佳位置和相关数据，临床应用该置钉技术，CT测量6例术后病人钉在寰椎侧块中的位置和螺钉长度。结果：寰椎椎弓根平均宽度为7．78mm，进钉点在寰椎椎弓根中线外缘2．2mm，即枢椎下关节突中点的矢状线，CT测量螺钉均位于寰椎侧块内，螺钉长度为28--30mm。结论：寰椎椎弓根钉进钉点可用枢椎下关节突中点的矢状延长线来确定，螺钉长度28--30mm。     

后路经寰枢关节螺钉内固定的枢椎解剖学测量

目的为后路经寰枢关节螺钉内固定术提供解剖学依据.方法在100例中国成人干燥枢椎标本上,对具有临床意义的数据进行解剖学测量.结果 96.5%的标本椎弓根宽度大于4.5 mm,11.5%标本侧块内侧高度小于2.1 mm,20.6%标本椎弓根内侧高度小于4.5 mm, 右侧占8.1%,左侧占12.5%,其中男性15.7%,女性40%的标本椎弓根内侧高度小于4.5 mm. 螺钉固定的上倾角和内倾角分别为39.2°±5.04°和5.79°±2.45°.结论[ HTSS〗21.5%的国人不适合后路经寰枢关节螺钉内固定术,女性明显高于男性,枢椎椎弓根变异较大,术前应进行旁矢状位的薄层CT扫描.     

寰椎侧块螺钉结合枢椎椎弓根螺钉治疗寰枢椎失稳

目的探讨寰椎侧块螺钉结合枢椎椎弓根螺钉治疗寰枢椎失稳的临床疗效和注意事项。方法对我院2006年1月至2011年1月采用寰椎侧块螺钉结合枢椎椎弓根螺钉治疗寰枢椎失稳48例患者的临床资料进行回顾性分析。结果本组患者随访时间为12~24个月,平均17个月,切口均Ⅰ期愈合,寰枢椎间均骨性愈合,无内固定破坏的病例发生,术后颈枕区疼痛得到改善,神经功能得到一定程度的恢复。并发症有术中静脉丛大出血2例,颈枕部疼痛和麻木加重3例,脑脊液漏2例,椎动脉挤压闭塞造成颅脑一过性缺血症状1例。结论寰椎侧块螺钉结合枢椎椎弓根螺钉技术是治疗寰枢椎失稳的有效手段之一,可获得满意的临床效果;规范手术操作是减少甚至杜绝手术并发症的关键。     

寰枢椎不稳后路椎弓根螺钉固定的三维有限元分析

目的:建立寰枢椎后路椎弓根螺钉固定系统三维有限元模型,分析寰枢椎后路椎弓根螺钉固定的稳定性。方法:1例寰枢椎不稳标本行后路椎弓根螺钉系统固定,采用螺旋CT扫描,通过工作站将扫描获得的图像导入计算机中,利用ANSYS8.0软件建立寰枢椎不稳三维有限元模型。给予模型加载不同边界条件,模拟寰枢椎的不同运动,分析寰枢椎不稳采用后路椎弓根螺钉固定的稳定性。结果:寰枢椎不稳采用后路椎弓根螺钉系统固定在不同运动状态下应力主要集中在枢椎椎弓根螺钉的根部。前屈运动时,椎弓根螺钉根部的应力为0.350×109Pa,前屈角度为0.7°;后伸运动时,椎弓根螺钉根部的应力为0.427×109Pa,后伸角度为1.2°;侧弯运动时,椎弓根螺钉根部的应力为0.295×109Pa,侧弯角度为0.3°;旋转运动时,椎弓根螺钉根部的应力0.635×109Pa,旋转角度为0.8°。结论:寰枢椎不稳采用后路椎弓根螺钉系统固定具有良好的术后即时稳定性。     

三维CT重建参照下徒手寰枢椎椎弓根螺钉置入内固定治疗外伤性寰枢椎不稳

背景：寰枢椎椎弓根螺钉内固定在三维CT重建参照下比传统方法能提高置钉的准确率,减少置入并发症。 目的：探讨以寰枢椎三维CT重建为参照,进行寰枢椎椎弓根螺钉内固定治疗外伤性寰枢椎不稳的方法,明确其手术指导意义以及临床治疗效果。　 方法：对30例因外伤导致寰枢椎不稳需行寰枢椎椎弓根螺钉内固定治疗的患者内固定置入前行三维CT重建。 结果与结论：与螺钉置入前设计钉道内倾度、设计钉道测得进钉点与中线的距离比较,经C1、C2椎弓根螺钉实际钉道内倾角及进钉点与中线的距离差异均无显著性意义。30例患者观察到的C1后弓及C2椎弓表面解剖特征与置入前CT容积再现的影像一致。说明根据三维CT重建图像为参照进行寰枢椎椎弓根螺钉内固定,徒手置入,节省时间,并减少术中接收X线辐射,个性化置钉,精确、安全性高、疗效优良。     

寰枢椎内固定的应用解剖学进展

近年随着对上颈椎疾病病理生理认识的加深和内固定器材的发展，出现了前路经口咽钢板固定术、前路经寰枢侧块关节螺钉固定术；后路寰椎侧块螺钉技术、枢椎椎弓根螺钉技术等寰枢椎内固定的新术式。本文试就针对这些新技术进行的应用解剖学研究作一综述。     

两种寰椎侧块螺钉固定方法的可行性比较

背景：寰椎侧块螺钉固定技术按其入钉点的不同可分为寰椎后弓下侧块螺钉固定和经寰椎后弓侧块螺钉固定(又称寰椎椎弓根螺钉固定),这2种固定方法各有优缺点,以往缺乏关于2种寰椎侧块螺钉固定方法骨性解剖可行性的比较研究, 目的：以测量国人寰椎相关骨性解剖数据为依据,比较2种寰椎侧块螺钉固定方法的可行性。 方法：收集30例(60侧)成人颈椎病患者的寰椎螺旋CT扫描数据,利用CT工作站对数据重建,分别测量寰椎侧块螺钉固定的关键骨性解剖数据,适合行经寰椎后弓侧块螺钉固定的标准为寰椎椎动脉沟处后弓高度和宽度≥ 4 mm;适合行经寰椎后弓下侧块螺钉固定的标准为寰椎后弓下侧块高度≥ 4 mm。 结果与结论：寰椎椎动脉沟处后弓高度为(4.54±1.17) mm,椎动脉沟处后弓宽度为(8.69±1.12) mm,寰椎后弓下侧块高度为(4.98±1.07) mm。寰椎后弓椎动脉沟高度大于4 mm(适合经寰椎后弓螺钉固定组)有41侧,占68%;寰椎后弓下侧块高度大于4 mm(适合经寰椎后弓下侧块螺钉固定)有52侧,占87%,2组差异有显著性意义(P < 0.05)。提示经寰椎后弓下侧块螺钉固定较经寰椎椎弓根螺钉更具可行性。术前利用CT测量寰椎关键解剖结构数据对制定个性化手术方案具有重要意义。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

Asymmetry of the internal connections of the striate cortex of the cat in the projection zone of the center of the field of vision

Studies were carried out on the organization of the internal connections of the striate cortex in cats in the projection zone of the center (0–5°) of the field of vision by microintophoretic application of horseradish peroxidase to electrophysiologically identified orientational columns. The area containing neurons showing retrograde labeling in most cases extended in the mediolateral direction. Labeled cells were located in the upper (II, III) and lower (V, VI) layers of the cortex, and the shapes and orientations of the areas containing labeled neurons in these layers coincided. Spatial asymmetry was detected in the distribution of labeled neurons relative to the orientational column studied. Labeled cells were located predominantly medial to the columns, regardless of the distance from the projection of the area centralis. Considering the visuotopical map of field 17, the asymmetry detected here provides evidence that neurons in orientational columns have more extensive connections with neurons of the peripheral part of the cortex. An asymmetrical distribution of “silent” zones around the receptive fields of neurons in orientational columns is suggested, and that these appear to receive influences from the periphery of the visual field. Laboratory of Visual Physiology and Laboratory of Central Nervous System Morphology, I. P. Pavlov Institute of Physiology, Russian Academy of Sciences, 6 Makarov Bank, 199034 St. Petersburg, Russia. Translated from Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 82, No. 12, pp. 23–29, December, 1996.     

Effects of the lesion of the postcommissural part of the septum on the behavior of the rat.

The effects of the lesion of the postcommissural part of the septum on behavior of the rat has been studied. Results may be summarized as follows. An increase in the exploratory behavior in the open field which decreases rapidly; a decrease in the number of defecations in this test and a decrease in time leaving a dark environment for exploration. In the shuttle box test, no facilitation of the acquisition, but a permanent and quite significant increase in the intertrial activity has been found. We conclude that the lesions tend to decrease the emotivity of the subjects. An interpretation on the basis of the species -- specific defensive reactions explains the transitory and permanent effects of the lesions on the spontaneous activity.     

The development of the ligament of the head of the femur

The hip joints of 30 human male and female fetuses and stillborns between 20 mm and 350 mm crown-rump length were studied by light microscopy. The ligament of the head of the femur developed in situ as a condensation of mesenchyme at the end of the second month of intra-uterine life (IUL), and was vascularized by branches of acetabular vessels early in the fourth month. In the majority of fetuses older than 5.5 months IUL, vessels in the ligament passed a short way into the femoral head within cartilage canals, to supply a small region around the fovea capitis. The remainder of the head was supplied by vessels in canals from around the upper part of the neck. The ligament changed from predominantly cellular to fibrous during the last 4 months of IUL. This increase in strength suggested significant mechanical functions in utero: limitation of adduction-flexion and opposition to postero-superior dislocation were the most likely.     

Counterpointing the functional role of the forebrain and of the brainstem in the control of the sleep-waking system

This paper reviews the lifetime contributions of the author to the field of sleep-wakefulness (S-W), reinterprets results of the early studies, and suggests new conclusions and perspectives. Long-term cats with mesencephalic transection show behavioral/polygraphic rapid eye movement sleep (REMS), including the typical oculo-pupillary behavior, even when the section is performed in kittens prior to S-W maturation. REMS can be induced as a reflex. Typical non-rapid eye movement S (NREMS) is absent and full W/arousal is present only after a precollicular section. The isolated forebrain (IF) rostral to the transection exhibits all features of W/arousal and NREMS [with electroencephalographic (EEG) spindles and delta waves], arousal to olfactory stimuli, and including the appropriate oculo-pupillary behaviors. These features also mature normally after neonatal transection. REMS is absent from the IF. After deprivation there is NREMS pressure and rebound in the IF, but the decerebrate cat only shows pressure for REMS. Most IF reactions to pharmacologic agents are within expectations, except for the tolerance/withdrawal effects of long-term morphine use which are absent. In contrast, these effects are supported by the brainstem (i.e. seen in the decerebrate cat). In cats with ablation of the telencephalon, or diencephalic cats, delta waves are absent in the thalamus. EEG thalamic spindle waves are seen triggering S for only 4-5 days after ablation. Therefore, true NREMS is absent in chronic diencephalic cats although pre- and postsomniac behaviors persist. These animals are hyperactive and show a pronounced, permanent insomnia; however, a low dose of barbiturate triggers a dramatic REMS/atypical NREMS rebound. Cats without the thalamus (athalamic cats), initially show a dissociation between behavioral hyperactivity/insomnia and the neocortical EEG, which for 15-20 days exhibits only delta and slower oscillations. Fast, low-voltage W rhythms appear later on, first during REMS, but spindle waves and S postures are absent from the start, such that these cats also display only atypical NREMS. Athalamic cats also show barbiturate-sensitive insomnia. Cats with ablation of the frontal cortices or the caudate nuclei remain permanently hyperactive. They also show a mild, but significant hyposomnia, which is permanent in afrontal cats, but lasts for about a month in acaudates. The polygraphic/behavioral features of their S-W states remain normal. We conclude and propose that: (a) the control of the S-W system is highly complex and distributed, but is organized hierarchically in a well-defined rostro-caudal manner; the rostral-most or highest level (telencephalon), is the most functionally complex/adaptative and regulates the lower levels; the diencephalic/basal forebrain, or middle level, has a pivotal role in inducing switching between S and W and in coordinating the lowest (brainstem) and highest levels; (b) W can occur independently in both the forebrain and brainstem, but true NREMS- and REMS-generating mechanisms exist exclusively in the forebrain and brainstem, respectively; (c) forebrain and brainstem S-W processes can operate independently from each other and are preprogrammed at birth; this helps understanding normal and abnormal polygraphic/behavioral dissociations in humans and normal dissociations/splitting in aquatic mammals; (d) NREMS homeostasis is present in the IF, but only REMS pressure after deprivation persists in the decerebrate cat; (e) the thalamus engages in both NREMS and W; (f) insomnia in diencephalic cats is the result of an imbalance between antagonistic W- and S-promoting cellular groups in the ventral brain (normally modulated by the telencephalon); (g) the EEG waves, which are signature for each S-W state, appear to truly drive the concomitant behaviors, e.g. a hypothetical human IF could alternate between behavioral NREMS and W/arousal/awareness; (h) a role for REMS is to keep the individual sleeping at the end of the self-limiting NREMS periods. The need for accelerating research on telencephaling NREMS periods. The need for accelerating research on telencephalic S-W processes and downstream control of the lower S-W system levels is emphasized.     

Topical organization of the projections of neurons of the substantia nigra and the ventral field of the tegmentum of the midbrain to the head of the caudate nucleus of the cat

Neuroscience and Behavioral Physiology -     

Ultrastructure of the endothelium of the drainage system of the eye

The endothelium of the ocular drainage system (Schlemm’s canal, collector tubules, and aqueous veins) in primary juvenile glaucoma undergoes degenerative dystrophic changes with compensatory hypertrophy and proliferation at the initial stages of the glaucomatous process and atrophy and desquamation at advanced and terminal stages. Progressive decrease in the pinocytous function of endotheliocytes, reduction of the protein-synthesizing and mitochondrial compartments of the cytoplasm, and formation of autophagosomes reflect the process of endotheliocyte degeneration in general. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 145, No. 5, pp. 574–577, May, 2008     

Involvement of the striatum in the central regulation of the hormonal functions of the gonads

Studies reported here show that intrastriatal administration of corticoliberin to rats decreases the blood testosterone level. However, in conditions of chemical deficiency of dopaminergic transmission in the dorsal striatum induced by injection of 6-hydroxydopamine, the effect of this neurohormone did not appear. It is concluded that extrahypothalamic corticoliberin is involved in regulating the hormonal reproductive system acting via dopaminergic mechanisms. Translated from Rossiiskii Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 85, No. 4, pp. 594–597, April, 1999.