颈椎前路手术中相关神经损伤并发症的常见原因及治疗

目的 回顾颈椎前路手术中相关神经损伤的常见原因及治疗方法.方法 2008年1月-2009年12月手术治疗859例颈椎病、颈椎后纵韧带骨化症及颈椎外伤行颈椎前路手术患者,对术后出现脊髓损伤症状加重及相关神经损伤的7例患者的临床资料进行回顾性分析.结果 859例患者中共5例发生脊髓损伤,发生率为0.58%;1例发生喉返神经损伤,发生率为0.12%;1例发生喉上神经损伤,发生率为0.12%.术后血肿发生脊髓损伤4例,经过清除血肿、甲基强的松龙等药物、高压氧及时治疗,均逐渐恢复至正常;术后发生脊髓损伤症状加重1例,经气管切开、呼吸机支持治疗及激素、高压氧治疗后脊髓损伤症状逐渐恢复至原有水平.术后发生喉返神经、喉上神经损伤患者2例经过激素、脱水等药物保守治疗,术后3个月内均恢复至正常.结论 颈椎病、颈椎后纵韧带骨化症及颈椎外伤患者行颈椎前路手术中均可能发生脊髓损伤及相关神经损伤,如能注意预防和及时治疗,预后较好.

Abstract：

Objective To review the relevant causes for and treatment of nerve injuries in the anterior cervical surgery. Methods From January 2008 to December 2009,859 cages of cervical spondylosis,ossification of cervical posterior longitudinal ligament and cervical spine trauma were treated by anterior cervical surgery.This study retrospectively analyzed the clinical data of seven cases who were with worsened symptoms of spinal cord injury and related nerve injury. Results Of 859 cases,five cases(0.58%)were with spinal cord injury,one(0.12%)with recurrent laryngeal nerve injury and one (0.12%)with laryngeal nerve injury.Hematoma occurred in four cases after surgery caused spinal cord injury and all the four patients recovered to normal after removal of the hematoma and timely treatment with mythylprednisolone and hyperbaric oxygen.Cervical spine trauma was worsened in one patient after the anterior cervical surgery.The patient restored to its original level of spinal cord gradually through some measures such as tracheotomy,ventilator support,hormone therapy and hyperbaric oxygen treatment.Laryngeal nerve injuries in two cases recovered to normal after conservative treatment with hormone,dehydration and other drugs within three months after surgery. Conclusions Anterior cervical surgery of cervical spondylosis,ossification of cervical posterior longitudinal ligament and cervical spine trauma are likely to induce the related nerve damage.The good prognosis can be obtained under timely prevention and treatment.     

胸腰段骨折并脊髓损伤再手术疗效分析

目的 探讨胸腰段骨折合并脊髓损伤患者I期前路/后路手术后Ⅱ期再手术的疗效.方法 回顾性分析2005年1月-2009年3月胸腰段骨折合并脊髓损伤单纯前/后路手术后残存后凸畸形伴神经功能恢复不全或未做Ⅱ期手术疗效患者12例.男9例,女3例;年龄19～57岁,平均34.6岁.根据Dems分型,爆裂型5例,压缩型5例,骨折脱位2例.I期前路手术5例,I期后路手术7例.I期手术后均存在不同程度的神经症状,对I期前路手术5例患者行Ⅱ期后路手术.I期后路手术7例者行Ⅱ期前路手术.I期手术至Ⅱ期手术最长18个月,最短12个月,平均时间13.4个月.通过影像学、神经功能及社会功能综合评估疗效,包括测量Cobb角、Frankel分级和日本骨科学会(JOA)评分.结果 术后切口均I期愈合.所有患者均获得随访,随访时间12～48个月,平均25个月.伤椎前、后缘高度压缩率术前平均42.6%、70.5%,术后平均恢复至92.5%、95,7%,至末次随访时为87.3%、92.2%;脊髓不完全损伤的患者神经功能均有Frankel 2级以上的改善.所有患者Ⅱ期术后胸腰椎生理弧度良好.Cobb角术前平均36.3°,术后矫正至5.8.,末次随访时为5.9°.JOA评分标准术后改善率,本组优9例,良2例,可1例,差0例.结论 对胸腰段骨折合并脊髓损伤患者I期前路/后路手术1年后残存神经或马尾临床症状患者行Ⅱ期手术减压后取得理想疗效,可获得满意的后凸畸形矫正和神经减压,神经功能均有不同程度恢复.

Abstract：

Objective To evaluate the outcome of reoperation(after I stage anterior/posterior operation)for thoracolumbar fractures combined with kyphosis and spinal cord injury. Methods A retrospective study was done on the medical records of 12 patients who underwent two-stage decompression with kyphosis and neurologic deficit due to single-stage approach(anterior or posterior) operation of thoracolumbar fractures combined with spinal cord injury between January 2005 and April 2009.There were 9 males and 3 females,at mean age of 34.6 years(range,19-57 years).According to the Denis classification,there were five patients with burst fractures,five with compression fractures and two with fracture dislocation.All the patients had couns medullaris injury.Of all the patients,five underwent one stage anterior approach surgery and the others underwent posterior approach operation.All the patients had vailous degrees of neurological symptoms.The patients treated with one stage anterior surgery were treated with two stage posterior surgery and the patients treated with one stage posterior surgery were treated with the two stage anterior operation.The mean interval from one stage operation to two stage decompression was 13.4 months(range,12-18 months).The radiologic,neurologic and functional outcomes were assessed through observation of the Cobb angle,Frankel spinal cord injury grading and Japanese Orthopaedic Association Scores(JOA). Results AIl the patients were followed up for mean 25 months (12-48months),which showed primary healing of the incisions in all the patients.The average anterior and posterior heisht of the vertebrae wers corrected from preoperative 42.6%and 70.5%to postoperative 92.5%and 95.7%and to 87.3%and 92.2%at the final follow-up respectively.Neurologic status was improved at least one Frankel grade in the patients who had preoperative incomplete paraplegia.The Cobb angle was corrected from preoperative 36.3°to postoperative 5.8°and to 5.9°at the final follow-up(P<0.05).No patient had any notable loss of correction between discharge and final follow-up.According to JOA coring,the results were excellent in nine patients,good in two and fair in one,with excellence rate of 92%. Conclusions Two stage decompression for epiconus and cauda equina syndrome resulted from one stage approach(anterior or posterior)operation of thoracolumbar fractures combined with spinal cord injury call attain satisfactory correction of the kyphosis and nerve decompression as well as various degrees of nerve function recovery.     

脊髓型颈椎病前、后路手术中经颅电刺激运动诱发电位与皮层体感诱发电位的联合监护作用

目的 探讨脊髓型颈椎病(cervical Spondylitic myelopathy,CSM)手术中经颅电刺激运动诱发电位(transcranial electrical stimulation motor evoked potential,TES-MEP)和皮层体感诱发电位(cortical somatosensory evoked potential,CSEP)联合监测脊髓功能的临床应用价值.方法 选自CSM手术中同时记录双侧胫前肌、足底躅短屈肌、鱼际肌的TES-MEP和双侧胫后神经和尺神经的CSEP共135例.根据TES-MEP、CSEP和联合监护结果与术后脊髓运动和感觉功能的比较,进行相关的统计学分析.结果 术中TES-MEP、CSEP、联合监护的成功检出率分别为87.4%、97.8%和100%.因手术操作引起诱发电位阳性共9例占6.7%.TES-MEP、CSEP判断脊髓运动功能的灵敏度分别为100%和83.3%,而判断脊髓感觉功能的灵敏度分别为77.8%和100%;联合监护的灵敏度和特异度均100%.结论 联合监护的成功检出率和准确性明显高于单一方法监护;手术操作引起诱发电位阳性的原因包括:前路椎管内的彻底减压、恢复椎间隙高度和生理弯曲的椎间植骨块或钛网植骨、合并后纵韧带骨化症的后路电磨惟板开槽,以及后路转前路手术时引流管不通的血肿压迫等.

Abstract：

Objective To evaluate of the efficacy of transcranial electrical stimulation motor evoked potential (TES-MEP)in combination with cortical somatosensory evoked potential (CSEP) monitoring during the anterior or posterior approach spinal surgery for cervical spondylitie myelopathy (CSM).Methods TES-MEP on the bilateral anterior tibial muscle and flexor hallucal brevis and thenar muscles and CSEP on the bilateral posterior tibial nerve and ulnar nerve were observed simultaneously in 135 patients during spinal surgery.Intravenous anesthesia was employed in all the patients.The results of TES-MEP,CSEP and combined monitoring were analyzed statistically.Pre-oporative and post-operative motor and sensory functions of the spinal cord were compared. Result Success rate of TES-MEP,CSEP and the combined monitoring was 87.4%.97.8%and 100%,respectively.Out of 135 patients,nine patients (6.7%) were detected with the positive evoked potentials due to surgical operation.The sensitivity of TES-MEP and CSEP in assessing the spinal cord motor function was 100%and 83.3%,respectively,while that in assessing the spinal cord sensory function was 77.8%and 100%,respectively.The sensitivity and specificity of the combined monitoring was both 100%. Conclusion The successful detection rate and accuracy of the combined monitoring for spinal cord function are apparently higher than that of simple TES-MEP or CSEP.The causes for operative maneuvers evoking a positive evoked potential include complete anterior decompression of the spinal canal,intervertebral bone graft,laminoplasty for OPLL and hematoma compression caused by a failed drainage in a posterior-anterior approach surgery.     

寰枢椎后路三种组合固定技术治疗寰枢关节不稳的临床评估

Objective To assess clinical curative effect of three types of combined posterior atlantoaxial internal fixation techniques in treatment of atlantoaxial instability. Methods The study involved 68 patients with atlantoaxial instability treated with different fixation techniques from August 2002 to March 2008. ( 1 ) Transpedicular fixation was performed in 32 patients including 20 patients with Anderson Ⅱ odontoid fractures (seven with old odontoid fracture and 13 with fresh fractures), six with type Anderson Ⅲ fresh odontoid fractures, four with disrupt of transverse ligament of the atlas and two with congenital loose odontoid process combined with atlantoaxial instability. (2) Transpedicular internal fixation with screws of atlas incorporating C2 laminar screws was performed in 20 patients with upper cervical injury including eight with type Ⅱ odontoid process fractures combined with atlantoaxial backward dislocation,four with type Ⅱ odontoid process fractures combined with atlantoaxial forward dislocation, two with nonunion of odontoid process fractures, three with type Ⅲ odontoid process fractures combined with atlantoaxial unsteadiness and three with atlantoaxial dislocation combined with disrupt of transverse ligament of atlas. (3)A total of 16 patients with traumatic atlantoaxial instability, reducible atlantoaxial dislocation and irreducible atlantoaxial dislocation were treated with four-point internal fixation technique using autologous iliac bone grafts. Results (1) A total of 120 screws were implanted in 32 patients, with no spinal cord or vertebral artery injury after surgery. Atlas lateral mass fixation was adopted in three patients because of broken posterior arch of the atlas. Postoperative CT showed that two screws were inserted into the vertebral artery hole and that one screw was inserted medially into the spinal canal and caused medial correx rupture, but both with no clinical symptoms. All 32 patients were followed up for 6-42 months ( average 26 months), which showed solid fusion in all patients. The postoperative JOA scores ranged from 13.2 points to 16.8 points (average 14. 8 points). (2) Thirty-two screws were implanted in 20 patients,with no spinal cord or vertebral artery injury. The patients were followed up for mean six months ( range 6-14 months). Postoperative X-ray showed sound bone fusion, with no cervical instability, loosening or breakage of the screws. (3) The symptoms of all the patients were improved at different degrees, with no neurological deterioration or severe complications, such as nerve blood vessel injury. All 16 patients were followed up for 8-26 months ( average 16 months), which showed bony fusion in all patients at 3-6 months after surgery. The spinal cord function was improved markedly in five patients, good in eight, mild in two but unchanged in one. Conclusions Three types of combined posterior atlantoaxial internal fixation techniques have advantages of rigid, short-segmental and three-dimensional fixation and hence are effective methods for treatment of upper cervical injuries. The combination mode can be varied according to specific condition of the patients.     

寰枢椎后路三种组合固定技术治疗寰枢关节不稳的临床评估

Objective To assess clinical curative effect of three types of combined posterior atlantoaxial internal fixation techniques in treatment of atlantoaxial instability. Methods The study involved 68 patients with atlantoaxial instability treated with different fixation techniques from August 2002 to March 2008. ( 1 ) Transpedicular fixation was performed in 32 patients including 20 patients with Anderson Ⅱ odontoid fractures (seven with old odontoid fracture and 13 with fresh fractures), six with type Anderson Ⅲ fresh odontoid fractures, four with disrupt of transverse ligament of the atlas and two with congenital loose odontoid process combined with atlantoaxial instability. (2) Transpedicular internal fixation with screws of atlas incorporating C2 laminar screws was performed in 20 patients with upper cervical injury including eight with type Ⅱ odontoid process fractures combined with atlantoaxial backward dislocation,four with type Ⅱ odontoid process fractures combined with atlantoaxial forward dislocation, two with nonunion of odontoid process fractures, three with type Ⅲ odontoid process fractures combined with atlantoaxial unsteadiness and three with atlantoaxial dislocation combined with disrupt of transverse ligament of atlas. (3)A total of 16 patients with traumatic atlantoaxial instability, reducible atlantoaxial dislocation and irreducible atlantoaxial dislocation were treated with four-point internal fixation technique using autologous iliac bone grafts. Results (1) A total of 120 screws were implanted in 32 patients, with no spinal cord or vertebral artery injury after surgery. Atlas lateral mass fixation was adopted in three patients because of broken posterior arch of the atlas. Postoperative CT showed that two screws were inserted into the vertebral artery hole and that one screw was inserted medially into the spinal canal and caused medial correx rupture, but both with no clinical symptoms. All 32 patients were followed up for 6-42 months ( average 26 months), which showed solid fusion in all patients. The postoperative JOA scores ranged from 13.2 points to 16.8 points (average 14. 8 points). (2) Thirty-two screws were implanted in 20 patients,with no spinal cord or vertebral artery injury. The patients were followed up for mean six months ( range 6-14 months). Postoperative X-ray showed sound bone fusion, with no cervical instability, loosening or breakage of the screws. (3) The symptoms of all the patients were improved at different degrees, with no neurological deterioration or severe complications, such as nerve blood vessel injury. All 16 patients were followed up for 8-26 months ( average 16 months), which showed bony fusion in all patients at 3-6 months after surgery. The spinal cord function was improved markedly in five patients, good in eight, mild in two but unchanged in one. Conclusions Three types of combined posterior atlantoaxial internal fixation techniques have advantages of rigid, short-segmental and three-dimensional fixation and hence are effective methods for treatment of upper cervical injuries. The combination mode can be varied according to specific condition of the patients.     

大鼠脊髓损伤后死亡原因分析

Objective To investigate the causes for death in rats after spinal cord injury.Methods A total of 120 adult Wister rats were selected for the study. The animal model with acute spinal injury at T10 was established by using Allen' s combat (25 g · cm). The dissection analysis was performed in death rats. Results Of all, 25 patients died, with mortality rate of 21%. Of death rats, five rats were died before awakening, with no abnormal anatomy; 12 rats died within three days after injury and three died of injuries 3-7days injury. Anatomy found pulmonary bleeding and edema, even hematocele bladder in some rats. There were three rats died within 1-2 weeks, one died of injury only after 2-3 weeks, with lung infection and urinary tract infection. There was no death after three weeks. Conclusions The early causes for death of rats with spinal cord injury is mainly due to lung congestion and pulmonary edema, whereas the leading cause of late death of rats is pulmonary and urinary tract infection.     

嗅球成鞘细胞植入大鼠挫伤脊髓内的迁移分布特征

目的 观察嗅球成鞘细胞(olfactory ensheathing cells,OECs)在损伤脊髓内的迁移分布与脊髓功能恢复的关系.方法 用NYU-impactorⅡ装置以10 g·25 mm损伤大鼠T10脊髓,1周后将急性分离、纯化、鉴定的绿色荧光蛋白(GFP)-大鼠OECs植入脊髓损伤部位及其首尾两侧,OECs的移植量为90 000/μl.在移植后13周时间内,镜下定性观察OECs在冰冻切片上的迁移分布特征,然后对其分布面积和长度进行半定量观察.脊髓运动功能用BBB评分法测定.结果 移植后早期OECs主要聚集在移植部位,并逐渐向周围迁移扩散,但主要沿脊髓纵轴向首尾方向扩展,脊髓空腔内也可见移植的OECs.OECs的分布面积和长度分别由术后1周时的1.33 mm2和4.23 mm逐步扩大到13周时的3.30 mm2和7.68 mm.与此同时,大鼠损伤脊髓的运动功能也得到逐步恢复.结论 OECs植入挫伤脊髓后可以迁移游走,且与大鼠脊髓运动功能恢复有一定关系.

Abstract：

Objective To observe the migration and distribution of OECs in injured spinal cord and discuss their relation with the recovery of spinal cord function. Methods The rats were contused by a force of 10 g · 25 mm with NYU-impactor at T10 level. The OECs acutely isolated from green fluorescence protein (GFP) rats were purified, identified and then transplanted into the injured site and the rostral and caudal parts of the spinal cord one week after injury, with total volume of the transplanted OECs for 90 000/μl. Within 13 weeks after transplantation, the migration and distribution of OECs were qualitatively observed on the cryo-sections under fluorescence light microscope. The area and the length of OECs distribution were semi-quantitatively determined. The locomotor function of the spinal cord was appraised by BBB score. Results OECs were located collectively in the transplanted site at early stage after transplantation and then spread gradually mainly along the long axis of the cord. OECs could be found in the cavity of the contused spinal cord. The area and the length of OECs distribution were increased from 1.33 mm2 and 4.23 mm respectively at one week to 3.30 mm2 and 7.68 mm respectively at 13 weeks after transplantation. In the meantime, the locomotor function was gradually improved. Conclusion OECs can migrate within the contused spinal cord, as may contribute to the recovery of locomotor function.     

高压氧对大鼠急性脊髓损伤炎症因子表达的影响

Objective To investigate the effects of early HBO therapy on the expressions of pro inflammatory cytokine mRNA including tumor necrosis factor-α (TNF-α ) and interleukin-10 (IL-10) following spinal cord injury (SCI) in rats. Methods Forty SD rats were randomly divided into 3 groups:the sham operation group (n=4) , the SCI group (n = 18) , and the hyperbaric oxygen group (n = 18). Spinal cord injury model was developed by using the modified Allen impact. Then, the SCI group and the HBO group received HBO therapy 2 hours after injury, once a day. And 3 rats were randomly selected at 6, 12, 24, 72, 120 and 168 h following injury to take samples of injured spinal cord tissue and measure dynamic changes in the expressions of TNF-α, IL-10 mRNA by semi-quantitative RT-PCR method. Results Faint expression of the cytokine mRNA could be noticed in the sham group. The expression of TNF-α mRNA in the injured spinal cord tissue in the SCI group elevated gradually, increased obviously at 12 h after injury and reached peak at 24 h, and its high expression maintained till 72 h after injury. The tendency in the expression of TNF-α mRNA in the HBO group was identical to that of the SCI group, however, the amplitude in the increase of TNF-α mRNA decreased (P＜0. 05). The expression of IL-10 mRNA in the SCI group began to increase at 12 h after injury and increased gradually over time and reached peak at 168 h. The expressions of both TNF-α and IL-10 mRNA were more consistent in the HBO group, with more obvious increase in the expressions of IL-10 mRNA. Conclusions HBO could reduce the release of pro-inflammatory cytokines and increase the expression of anti-inflammatory cytokines,resulting in reduction of secondary spinal cord injury,protection of the damaged nerve cells and promotion of recovery.     

少突胶质前体细胞移植治疗对大鼠脊髓损伤轴突髓鞘化的影响

Objective To investigate the effects of transplantation of oligodendrocyte precursor cells (OPCs) on axonal myelination after spinal cord injury in a rat model. Methods A rat model of spinal cord injury at the tenth thoracic vertebral level (T10) was produced by Allen weight-drop impact method. OPCs implantation was performed at the subacute stage of spinal cord injury. Effects of OPCs transplantation on axonal myelination after spinal cord injury were evaluated by HE staining, immunohistochemistry, myelin staining and transmission electron microscopy. Results The implanted cells were still observed in lesioned segments of spinal cord eight weeks after transplantation. The results of HE staining clearly showed better structure of spinal cord in OPCs-transplanted group than that of control group.Myelin staining also demonstrated that the amount of myelin in white matter of lesioned cord in the OPCs-transplanted group (7 802.42 ± 1085.58) was higher than that of the control group (5 055.98 ± 916.74)(P ＜0.01 ). Expression of myelin basic protein (MBP) was significantly increased in the OPCs-trans-planted group (8 544.44 ±812.78) as compared with that of the control group (5 243.83 ±808.27)(P＜0.01). Moreover, transmission electron microscopy further confirmed the improvement of micro-structure of myelination in OPCs-treated rats. Conclusion OPCs transplantation can improve axonal myelination in rat with spinal cord injury.     

重型颅脑损伤患者血清血栓调节蛋白和血管性假血友病因子动态变化及其临床意义

Objective To investigate the changes of thrombomodulin (TM) and von Willebrand factor (vWf) and their clinical significance in patients with severe brain injury. Methods The study involved 62 patients with severe brain injury who were divided into diffuse axonal injury group (28 patients) and focal brain injury group (34 patients). Then, the 62 patients were divided into young group (16-30 years old, 20 patients), middle-aged group (31-65 years old, 20 patients) and elderly group ( ＞65 years old, 22 patients). The serum levels of TM and vWf were determined at days 1 and 7 after injury respectively. ELISA method was employed to determine the serum levels of TM and vWf.Results The vWf in focal brain injury group was significantly higher than that of diffuse axonal injury group at days 1-7 after injury ( P ＜ 0.05 ). Compared with the young and middle-aged groups, the TM and vWf levels in the elderly group at day 1 after injury were significantly elevated ( P ＜ 0. 05 ). The TM levels in patients with delayed traumatic intracerebral hematoma (DTICH) were significantly higher than that in patients without DTICH (P ＜ 0. 05). Conclusions In the acute stage of severe brain injury,injury severity and activation of endothelial cells varies in patients with different types of injury and at different ages. TM is one of sensitive indicators to reflect the cerebal vascular endothelial cell injury. It is very meaningful to assess the prognosis of severe brain injury by measuring serum levels of TM and vWf and take TM as a predictive indicator for DTICH.     

颈后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病

目的探讨颈后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病的疗效及手术前后影像学变化。方法用颈后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病病人68例,用JOA17分法评价术前,术后功能恢复及临床症状消失的情况,测量术前术后椎管矢状径变化。结果 68例患者均获随访,随访时间平均12.3个月,术后病人均获不同程度症状改善。术后颈椎椎管矢状径扩大明显。结论该术式治疗多节段脊髓型颈椎病具有操作简单、安全性高、疗效确切的优点,并且只有严谨操作和围术期处理,才能有效避免各种并发症的发生。早期手术可防止脊髓损伤继续加重。     

Ⅰ期前路颈椎复位减压及椎间植骨融合内固定术治疗下颈椎AO C型F4亚型单节段损伤

目的 探讨Ⅰ期前路颈椎复位减压、椎间植骨融合内固定术治疗下颈椎AOC型F4亚型单节段损伤的疗效.方法 采用回顾性病例系列研究分析2012年1月至2019年12月郑州市骨科医院收治的45例下颈椎AO C型F4亚型单节段损伤患者临床资料,其中男31例,女14例;年龄23～78岁[(48.5 ±3.7)岁].损伤节段:C4/...     

一期后前路联合手术治疗老年人脊髓型颈椎病

目的 评估一期后前路联合手术治疗老年人脊髓型颈椎病的安全性及疗效.方法 回顾性分析2007年1月-2010年1月接受一期后前路联合手术治疗脊髓型颈椎病的34例老年患者(男24例,女10例,年龄60～76岁)的临床资料,以同期收治的54例中青年患者(男43例,女11例,年龄29 ～ 59岁)作为对照,对两组患者的术前病程、术前合并症、前路减压节段数、出血量、术后引流量、术后并发症和平均住院日进行比较,按日本矫形协会(JOA)评分对两组患者术前、出院时及末次随访时的神经功能进行评价与比较.结果 老年患者的术前合并症、出血量、术后引流量及 并发症发生率均明显高于中青年患者(P＜0.05),术前病程、减压节段数、平均住院日、手术前后及末次随访时的JOA评分两组比较差异无统计学意义(P＞0.05).结论 通过正确的围术期处理、积极防治并发症,一期后前路联合手术治疗老年人脊髓型颈椎病安全有效.     

椎体次全切除术加钛笼植入治疗陈旧性下颈椎骨折脱位

目的探讨椎体次全切除术加钛笼植入治疗陈旧性下颈椎骨折脱位的效果。方法回顾性分析2006年1月~2014年1月应用前路椎体次全切除术、椎体间钛笼植入(自体骨填充植骨)、钛板内固定术治疗的37例陈旧性下颈椎骨折脱位合并脊髓损伤患者的临床资料,男性25例,女性12例;年龄19~61岁,平均42岁。术前脊髓功能状况(JOA评分):完全性损伤8例,平均JOA评分1分;不完全性损伤29例,平均JOA评分5分。结果平均随访14个月,椎间高度和生理曲度获得良好重建,无钛板、螺钉松动断裂并发症。不完全性脊髓损伤患者的神经功能获明显改善(平均JOA评分从5分提高至13分),完全性脊髓损伤患者获得损伤平面神经根功能的改善。结论采用前路椎体次全切除术加钛笼植入治疗陈旧性下颈椎骨折脱位具有脊髓减压充分、有效恢复颈椎序列和生理曲度、获得即刻和永久的稳定性、促进神经功能恢复等特点。     

改良颈椎椎体次全切除术临床疗效随访

采用改良式颈椎椎体次全切除术治疗６６例多节段脊髓型或脊髓神经根混合型颈椎病。手术有效率为９５．５％（６３例），优良率为８４．８％（５６例），无手术死亡或重残发生。该术式的优点是手术野较大，脊髓损伤机会少，能同时直接去除椎间盘水平和椎体后方的脊髓压迫，且可避免椎体切除过多和脊髓减压不充分，镶嵌植骨和术后颈胸口膏围领外固定能防止植骨块脱出和确保植骨融合。最为适宜２￣４个节段的脊髓型或脊髓神经根混合型颈     

椎体次全切除植骨融合治疗多平面脊髓型颈椎病

报告了椎体次全切除植骨融合治疗多平面脊髓型颈椎病15例。术后13例随访4～42个月,其中10例显效或有效。椎体次全切除植骨融合的优点在于:(1)能直接解除脊髓前方的压迫,不仅限于椎间隙平面,还包括椎体平面,因而减压较为彻底;(2)植骨不融合的发生率较低;(3)术野较大,便于在显微镜下操作。可有效地避免直接损伤脊髓和神经根。作者强调手术减压要彻底,植骨融合需稳固。     

颈椎前路一体化钢板融合器的临床应用

目的 评价颈椎前路一体化钢板融合器治疗颈椎间盘突出症的长期疗效. 方法 对54例症状性退行性颈椎间盘突出症和急性颈椎间盘突出症患者行前路椎间盘切除减压一体化钢板融合器置入术.术后行日本脊柱学会(JOA)评分,X线片观察融合情况.随访12～79个月,甲均53.2个月.结果 所有患者术中无并发症发生.随访显示椎间隙高度和脊柱前凸已恢复,无器械断裂、远期不稳定或假关节形成.1例急性椎间盘突出脊髓部分损伤患者和3例症状严重脊髓型椎间盘突出患者症状改善不明显,其余患者治疗效果良好.术后JOA评分为13～17分,平均16.1分,术后改善率为86.7%,融合率100%. 结论 颈椎前路一体化钢板融合器治疗颈椎间盘突出症有其生物力学优势,是颈椎前路融合固定一项可靠的技术.     

发育性颈椎管狭窄合并脊髓型颈椎病的临床特征与手术疗效

目的探讨发育性颈椎管狭窄合并脊髓型颈椎病的临床特征与手术治疗效果。方法 89例发育性颈椎管狭窄合并脊髓型颈椎病患者采用颈椎体次全切除治疗42例,Cloward环锯法手术27例,采用单开门颈椎管扩大成形术20例。前路手术同期均采取自体髂骨植骨融合。结果本组患者无手术并发症发生。89例获12～56个月的随访,平均随访(16.8±2.6)月,按照JOA评分系统评价治疗效果,术前评分平均(9.5±0.3)分,术后6、12个月评分平均(13.1±0.2)分、(14.2±0.4)分,术后6、12个月JOA评分与手术前比较差异有统计学意义(P<0.05),术后6、12个月JOA平均改善率57.2%、64.3%。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。     

MRI在脊髓型颈椎病中的研究进展

在脊髓型颈椎病(CSM) 的诊断中,常规MRI上脊髓的信号改变与神经功能障碍密切相关,扩散张量成像（DTI）和磁共振波谱（MRS）可以作为寻找神经功能损伤放射学标志物和了解脊髓生理学的工具,而功能MRI（fMRI）有助于评估CSM减压术后神经功能恢复情况。综述常见MRI技术在CSM病人诊断与治疗中的研究进展。