下颈椎屈伸运动对椎间孔面积影响的实验研究

目的：定量描述下颈椎屈伸运动时椎间孔面积变化。方法：对５具正常成人男性新鲜颈椎标本行动态Ｘ线４５°斜位摄片，图象分析计算椎间孔面积。结果：屈曲时颈椎间孔面积增大，伸展时缩小。其中Ｃ３～４，Ｃ４～５变化最大。Ｃ３～４节段椎间孔面积与椎间角度呈直线关系，也可拟合为Ｌｏｇｉｓｔｉｃ曲线。结论：屈曲时椎间孔面积增大对颈椎病变神经根刺激症状的诊断和治疗具有相应临床意义     

颈椎生理曲线异常和颈椎病的发病学

作者复习了１５６例脊髓型颈椎病的临床表现，影像学及手术所见，完成了３９例１３～１４岁少年组，２７例脊髓型颈椎病组和２９例成人对照组的屈伸动态Ｘ线摄片和Ｃ２～Ｃ７各椎间屈伸活动度的测量。结果表明脊髓型颈椎病组椎间活动度明显减小和再分配。１０９例颈椎病人Ｘ线侧位片显示颈椎生理曲线折断。结论为：（１）椎间活动度异常是颈椎退变常见和重要征象，颈椎生理曲线“折断”提示该椎间超限前屈和后伸，其连接结构承受常应     

正常国人颈椎屈伸运动范围X线图像的计算机测量分析

目的　通过观察正常国人的颈椎屈伸运动范围 ,了解颈椎发生退变的规律 ,为进一步探讨颈椎节段性不稳定提供参考依据。　方法　应用自行设计的颈椎X线图像分析处理系统对 3 82例正常国人的颈椎全屈、全伸位X线平片 (共 764张 )进行了测量和统计分析。 3 82例测试者中 ,男性2 14例 ,女性 168例 ;同性别间按年龄分组 :2 0～ 3 9岁者为A组 ,4 0～ 5 9岁者为B组 ,60～ 76岁者为C组。测量参数主要为颈椎全屈伸运动的总活动度 (C2 ～C7)及各节段的椎间活动度。　结果　颈椎全屈伸运动的总活动度A组明显大于B组和C组 (P <0 0 1) ,B、C两组间差异无显著性意义 (P >0 0 5 )。最大椎间活动度节段在A组位于C5～C6 ,在B、C组则位于C4～C5。最小椎间活动度节段在各组中均位于C2 ～C3。各测量结果在性别间无统计学差异 (P >0 0 5 )。　结论　颈椎屈伸运动范围及其退变情况在性别上无明显差异 ;颈椎总的屈伸活动度随着年龄的增长而递减 ,然后趋于稳定 ;最大椎间活动度节段则随年龄的增长由C5～C6 节段上移至C4～C5节段。     

中,下位颈椎单开门椎管扩大术式的生物力学稳定性研究

在７具新鲜尸体的颈椎上定量地研究了正常结构和单开门椎管扩大术式后的中、下部颈椎各节段 （Ｃ２～ Ｃ６）的前屈、后伸、左／右侧弯运动。所施加的最大力矩为 １． ５ Ｎｍ。摄影记录椎骨的运动，计算得到中性区（Ｎｅｕｔｒａｌ　ｚｏｎｅ）和运动范围（Ｒａｎｇｅ ｏｆ ｍｏｔｉｏｎ）。结果表明在Ｃ３～Ｃ３处行单开门椎管扩大术式后，各节段的前屈和侧弯运动均有所增加，而后伸运动则有增有减。Ｃ５～Ｃ６节段的运动增加最大，其前屈、后伸和侧弯运动分别增加 １． ８°、 ０． ６°和０． ８°，所增度数分别占完整颈椎前屈、后伸和侧弯运动的３９％、２４％和３０％。为此，建议术后应在Ｃ５～Ｃ６处行固定术，以防该节段失稳。     

改良双开门颈椎管再造术对脊柱稳定性的影响

对６具新鲜人体颈段脊柱标本定量地分析正常颈椎和改良双开门椎管再造术后中下段颈椎（Ｃ３～Ｃ７）各节段的前屈／后伸，左／右侧弯运动，所施加的最大纯力矩为２．０Ｎ．Ｍ，用立体摄影，计算机采集各节段颈椎运动情况，得到运动范围（ＲＯＭ）和中性区（ＮＺ）。将正常颈椎作为自身对照，然后摹拟临床手术对Ｃ５、Ｃ６行改双开门术，结果表明，改良双开门颈管再造术对脊柱的稳定性无明显影响。     

纵向撞击性损伤对颈椎三维运动稳定性影响的生物力学研究

目的：研究Ｃ２～Ｃ４椎体标本在不同能量的纵向撞击性损伤前后的颈椎三维运动变化，按脊柱稳定性标准划分不同部位颈椎的损伤阈值。方法：１４例成年男性新鲜尸体的Ｃ２～Ｃ４椎体，用脊柱三维运动试验机对颈椎标本施加前屈、后伸、左右侧弯和左右轴向旋转的纯力偶矩，由脊柱三维运动双平面立体测量的计算机图像处理系统得到纵向撞击性损伤前后的颈椎各节段的运动范围（ＲＯＭ）。结果：３０Ｊ能量撞击后，Ｃ２～Ｃ３节段的前屈、右轴向旋转的ＲＯＭ有显著性增加。５０Ｊ能量撞击后，Ｃ２～Ｃ３节段的前屈、后伸和左／右轴向旋转的ＲＯＭ显著性加大。Ｃ３～Ｃ４节段的前屈ＲＯＭ增大显著。结论：撞击能量越大，颈椎丧失稳定性的方向也越多；在相同能量的撞击作用下，不同节段颈椎不稳定的方向不同；多个节段承受纵向撞击作用时，靠近撞击的节段丧失的稳定性方向数目较多。依据稳定性评价得到的损伤阈值低于放射学诊断作出的损伤阈值。     

颈椎前、后路手术的运动学变化

目的：为评价几种颈椎前、后路手术对颈椎稳定性的影响。方法：取四具意外伤亡的新鲜尸体Ｃ２～Ｔ１标本，保留所有韧带和椎间连接，行如下手术：１．Ｃ５，６椎间盘切除；２．椎间植骨；３．前方椎体钢板螺钉内固定；４．Ｃ５全椎板减压；５．Ｃ５，６椎弓根钢板螺钉内固定（去除该部椎体钢板）；６．去除椎弓根钢板和植骨块。测量上述诸术Ｃ２～Ｔ１各节段间的前屈、后伸、左右侧弯，左右旋转运动变化，以完整标本作对照。结果：Ｃ５，６椎间盘切除后的前屈运动增加６７．８％（Ｐ＜０．０１），后伸运动增加５９％（Ｐ＜０．０１），侧弯和旋转运动增加１０％（Ｐ＞０．０５）。植骨后运动变化不明显（Ｐ＞０．０５）。椎体钢板和椎弓根内固定后各向运动均明显减少（Ｐ＜０．０１），以侧弯和旋转尤为明显，椎弓根固定后明显增强三维稳定性。而椎体钢板固定的旋转稳定性最佳。然椎间盘和椎板同时切除引起三维运动明显不稳。损伤和固定节段的运动增大和减小，伴随其相邻上或下节段运动的代偿性减小和增大，但无显著性。结论：以上结果为临床开展颈椎前、后路手术所造成的稳定性变化和在手术内外固定方法的选择上提供了运动学和生物力学理论参考     

牵引对颈椎生物力学影响的实验研究

目的　探讨不同牵引角度及重量对颈椎生物力学的影响。方法　将５ 具颈椎标本（ Ｃ１ ～７）制成颈椎生物力学模型,观察牵引对下颈椎椎体（ Ｃ４ , Ｃ５） 和椎间盘（ Ｃ４ ～５ , Ｃ５ ～６） 应变以及颈椎总体位移的影响。结果　前屈１５°牵引时,椎体的应变增加最大,中立位和前屈１５°牵引时,椎间盘的应变增加最大,前屈２５°和后伸２５°牵引时,颈椎总体位移增加最大。上述各角度牵引后应变位移的线性变化以４ ～６ ｋｇ 较好。结论　在前屈１５°、中立位４ ～６ ｋｇ 的牵引较为符合人体颈椎的生物力学原理。     

颈椎损伤20例临床分析

颈椎损伤２０例临床分析吴江本院１９８４年以来共收治颈椎损伤患者２０例，均为男性，年龄在１９～６８岁，平均４３，５岁。损伤平面Ｃ（１～２）４例，Ｃ（３～４）３例，Ｃ（４～５）４例，Ｃ（５～６）９例，Ｃ（６～７）７例；其中７例为多节段损伤。损伤类型：屈曲...     

颈椎关节半脱位征像的诊断价值

目的：探讨颈椎Ｘ线片上半脱位征像的临床诊断意义；方法：对８７例颈痛和２１例无症状患者的颈椎Ｘ线片进行研究，内容包括齿突侧块间距、棘突偏歪和双边征等；结果：绝大多数左右齿突侧块间距不对称，棘突偏歪和双边征较为常见，多见于Ｃ５、Ｃ４和Ｃ６颈椎。两组间所谓颈椎半脱位的发生率相等。结论：对颈椎关节半脱位的提法值得商榷。颈椎关节半脱位的诊断应当有两种，一是单纯的Ｘ线学诊断，二是结合临床体查结果的临床诊断。     

Thoracic and lumbar meningocele in neurofibromatosis type 1. Report of two cases and review of the literature

We report two cases of ventrolateral thoracic and lumbar meningoceles associated with neurofibromatosis type 1, and present a review of the literature. Thoracic and lumbar meningoceles are rare lesions which are associated with neurofibromatosis in 60% to 85% of cases. Large meningoceles may cause pain, neurological signs, or respirtory complaints when located intrathoracically. Surgery is indicated in such cases, as well as when small meningoceles enlarge with time. The etiology of meningoceles in neurofibromatosis remains controversial. The authors postulate that ventrolateral lesions of the thoracic and lumbar spine are secondary to congenital mesodermal dysplasia and hypoplastic bone changes. MRI is the diagnostic method of choice, since it most adequately visualizes the pathological anatomy of the spinal cord, meninges, and adjacent structures in every sectional plane. CT scans are pacticularly useful in assessing the spinal bony changes.     

Posterior stabilization of the lower cervical spine with lateral mass plates and screws

Posterior cervical fixation using lateral mass plates and screws is becoming increasingly used and accepted.Advantages include increased rigidity, ability to be used in cases where the lamina or spinous processes are deficient or missing, use across the occipito-cervical or cervico-thoracic junction, and need for less postoperative bracing. Safe placement of lateral mass screws requires complete exposure and identification of the boundaries of the lateral masses. The starting point for screw placement is 1 to 2 mm medial to the center of lateral mass. The screws are angulated outward 10 to 20 degrees and cranially 20 to 30 degrees to be parallel to the facet joints. An adjustable drill guide facilitates safe drilling and tapping techniques. All 102 patients with unstable cervical spines treated with AO reconstruction plates and autogenous bone graft had healed fusions based on flexion-extension radiographs. The reductions achieved postoperatively were maintained at follow-up. Two patients had transient radiculopathies secondary to screw placement. The indications for lateral mass fixation include cases where the lamina or spinal processes are deficient or missing, multilevel or rotational instabilities, when extension to the thoracic spine or occiput is required or when decreased bracing is beneficial.     

上颈段颈椎脊髓病

目的：一般认为颈椎脊髓病好发于下颈段Ｃ５６最常见，其次为Ｃ６－７。有时上３个颈椎受累，由于神经系统病变定位困难，尤其ＭＲＩ应用于临床前的影像学缺欠，常使上颈脊髓病被误认作下颈段病变。本文旨在说明上颈段脊髓病的发病，病理及神经系统症状特点，方法：对１５６例颈椎脊髓病中２８例上颈段病变的临床表现，影像学特点，手术所见及随访结果作了研究，诊断依据为肱二头肌腱反射亢进，试图引进肱二头肌或肱桡肌反射时，出现     

Minimally invasive endoscopic surgeryof the lumbar spine

The usefulness of endoscopic techniques in orthopaedics as well as in general surgical, gynecologic, urologic, andthoracic procedures is well established. Endoscopic techniques in coronary bypass surgery are being developed. The development of the minimally invasive endoscopic approach to the thoracic and lumbar spine is a technique prompted by the surgeons desire to increase access to the spine while decreasing morbidity. In this article, we address the laparoscopic and retroperitoneal approaches to the lumbar spine. Discussion focuses on indications and applications of the procedures as well as operative setup. Finally, surgical experience is reviewed.     

Significance of Resegmentation in the Pathogenesis of Vertebral Body Malformation

Human embryos and fetuses were investigated histologically to elucidate the possible pathogenesis of congenital malformations of the vertebral body. Special attention was paid to the early development of the vertebral column, particularly the often-questioned stage of resegmentation, important as the stage during which the malformations might develop. Evidence of resegmentation was found in 7 embryos ranging from 7 mm C-R length (5 weeks after fertilization) to 13 mm (6 weeks). Moreover, the formation of the definitive vertebral body was considered to be intimately related to the intersegmental artery. As for Junghanns' concept that the cartilaginous body consists of two lateral halves, it was not observed in our specimens, nor was it found in the latest literature on normal vertebral development. Congenital malformations of the vertebral body were classified into two categories: failure of formation and failure of segmentation. They were demonstrated in an embryo of 13 mm and a fetus of 70 mm which were in the developmental stages of chondrification and early ossification, respectively. According to these observations, we conclude that most malformations of the vertebral body occur in the early stage of definitive vertebral body anlage formation.     

Cervical spine trauma

Cervical spine trauma is a common problem with a wide range of severity from minor ligamentous injury to frank osteo-ligamentous instability with spinal cord injury. The emergent evaluation of patients at risk relies on standardized clinical and radiographic protocols to identify injuries; elucidate associated pathology; classify injuries; and predict instability, treatment and outcomes. The unique anatomy of each region of the cervical spine demands a review of each segment individually. This article examines both upper cervical spine injuries, as well as subaxial spine trauma. The purpose of this article is to provide a review of the broad topic of cervical spine trauma with reference to the classic literature, as well as to summarize all recently available literature on each topic.

Identification of References for Inclusion:

A Pubmed and Ovid search was performed for each topic in the review to identify recently published articles relevant to the review. In addition prior reviews and classic references were evaluated individually for inclusion of classic papers, classifications and previously unidentified references.     

Men with hip fractures have poorer nutritional status and survival than women

Background Many hip fracture patients have a poor nutritional status which may be one explanation for their increased mortality.

Patients and methods We studied nutritional status and other mortality-related factors prospectively in 165 patients with hip fractures (85 women). We concentrated on differences between death rates and survival rates at 3 months and at 1 year, and between those patients who died within 3 months and those who died later.

Results In general, men had a poorer nutritional status and a larger number of comorbidities. Also, there were more smokers and alcohol abusers amongst the men. Of the patients who died during the first 3 months, most were men, and their initial nutritional status was poorer than that of women. Multivariate logistic regression analysis revealed a correlation between mortality and total serum protein, retinol binding protein and the number of comorbidities. Among patients who died after 3 months, mortality was associated with the number of comorbidities and smoking.

Interpretation The higher mortality rate in men than in women after hip fracture may in part be explained by the poor nutritional status in men.     

Computerized tomography after internal fixation of the spine

32 patients with internal fixation of the spine were postoperatively examined by computerized tomography. Details of metallic osteosynthetic material were demonstrated in all our cases. Bony structures were well defined in 27 patients, whereas soft tissue imaging was degraded by scattering artifacts in 14 of 20 examinations. Application of intrathecal contrast medium, however, was helpful for the evaluation of intraspinal soft tissues. Involvement of extraspinal soft tissues could be interpreted on the basis extent of vertebral osseous destruction.     

A comprehensive classification of thoracic and lumbar injuries

European Spine Journal - In view of the current level of knowledge and the numerous treatment possibilities, none of the existing classification systems of thoracic and lumbar injuries is...     

Indications for surgery in upper cervical spine injury

20% of all spine injuries are cervical spine injuries. Surgical treatment of these injuries must take into account the great mobility of this part of the spinal column. Therefore, biomechanical aspects must be considered, especially in the upper cervical spine — C1 and C2. Describing our own therapeutical regimen in 35 patients with unstable upper cervical spine injuries we explain the biomechanical background and review the literature. It becomes evident that ventral approaches are superior to dorsal techniques for decompression, reposition, and stabilization with minimal loss of mobility.