单开门式脊神经后根切断术治疗痉挛性脑瘫

目的：采用单开门式选择性脊神经后根切断术治疗痉挛性脑瘫。方法：保留椎板棘突、椎板开槽、绞链式翻转、暴露硬膜脊神经根、选择性切断脊神经后根。结果：临床应用１６例，随访６～１２个月，近期疗效满意。结论：可恢复椎弓后部结构，最大限度地减少手术对脊柱稳定性的影响，从而较好地防止腰椎肌乏力、腰椎滑脱、过伸畸形等并发症的发生。     

改良腰骶SPR治疗痉挛性脑瘫

目的：通过对腰骶段选择性脊神经后根切断术(SPR)的改良，以期提高治疗痉挛性脑瘫的疗效，减少并发症。方法：对23例痉挛性脑瘫患者行腰骶段SPR，采用全椎板切下原位同植；6例肢体痉挛较重者同时做选择性脊神经前根切断术(SAR)；5例患肢挛缩畸形较重者，选择性神经根切断后，Ⅰ期行矫形于术。结果：23例术后1周内疗效评价：优21例(91％)；良2例(9％)。19例得到8个月～3．6年(平均2年)随访，疗效评定优15例（80％）；良4例(20％)。结论：SPR术中采用全椎板切下原位回植能维持腰椎稳定性，部分SPR结合Ⅰ期矫形术能够提高治疗效果。     

选择性脊神经后根切断术对痉挛性脑瘫运动功能中远期随访疗效分析

目的 报道选择性脊神经后根切断术治疗痉挛性脑瘫的运动功能中、远期随访疗效。方法 收集1992年10月～2000年12月施行选择性脊神经后根切断术治疗的脑瘫共195例，男142例，女53例，年龄最小的为3岁，最大的为22岁，平均为6．9岁。根据运动功能评分评定手术前后的运动功能。结果 选择性脊神经后根切断术对运动功能有改善。术前不能独立行走的共有37例，其中20例复诊时具有独立行走的能力。结论 选择性脊神经后根切断术远期可改善患者站立和行走时的交叉和尖足畸形，改善患者行走步态，提高患者的运动功能，尤其是改善独立行走能力。     

SPR治疗脊髓损伤后下肢痉挛的临床观察

目的:探讨采用选择性脊神经后根切断术(SPR)治疗脊髓损伤后下肢痉挛的效果。方法:16例患者术前3d进行步态分析,术中对支配痉挛下肢的L2～S1的脊神经后根进行分束,电刺激仪测阈值,将阈值较低神经束切断。神经根切断比例结合肌张力、肌力、体重及肌群功能进行量化,均小于30%。结果:术后步态有明显改善(P<0.01)。16例平均随访3年,痉挛解除率90%,功能改善率80%。结论:选择性脊神经后根切断术能较有效地治疗脊髓损伤后下肢痉挛。     

选择性脊神经后根切断术治疗脊髓损伤后下肢痉挛的疗效观察

国内外采用选择性脊神经后根切断术（selectiveposteriorrhizotomy，SPR）治疗脑瘫均取得较好的疗效［１～５］。作者自１９９４年２月～１９９７年４月采用选择性脊神经后根切断术治疗脊髓损伤后的肢体痉挛，获得满意疗效。资料与方法一、一般资料１９９４年２月～１９９７年４月采用SPR手术治疗脊柱骨折、结核后期肢体痉挛４２例，随访２９例。男１８例，女１１例；年龄２３～４７岁，平均２９岁。２４例为胸腰椎骨折，伤后均行减压固定术，后期出现单侧肢体痉挛１６例（右下肢９例，左下肢７例），双下肢痉挛８例。其中５例爆裂型骨折…     

双侧连续开窗式选择性脊神经后根切断治疗脑瘫下肢痉挛

选择性脊神经后根切断术 (selective posterior rhizotomy,SPR)治疗脑瘫 ,手术切除腰骶段棘突、韧带及全椎板切开硬膜术后部分病例出现腰椎滑脱、过伸畸形等并发症。为了尽量减少影响脊柱稳定性 ,我们采用双侧连续开窗式 SPR治疗脑瘫下肢痉挛 2 1例。全部患者双下肢均呈尖足交叉畸形 ,足尖着地 ,扶持下行走 15例 ,均呈剪刀步态。术前腰椎 X线检查未见异常。手术方法 :手术在全麻下进行 ,俯卧位自 L1 ～ S2 后正中部切口 ,不损伤棘上韧带、棘突 ,显露双侧椎板 ,行双侧 L1 ～L2 、L2～L3、L3～L4、L4～ L5 、L5 ～ S1 开窗并扩大棘突…     

选择性脊神经后根切断术治疗痉挛性脑瘫3年随访分析

选择性脊神经后根切断术治疗痉挛性脑瘫３年随访分析朱庆棠，劳镇国，朱家恺，刘小林，程钢为进一步观察选择性脊神经后根切断术（ＳＰＲ）的疗效和并发症，对我科１９９３年３月－１９９６年５月间接受ＳＰＲ治疗的９６例痉挛性脑性瘫痪（ＳＰＲ）患者近３年随访观察，其...     

SPR治疗成人脊髓损伤后肢体痉挛的临床及电生理观测

目的 :对选择性脊神经后根切断术 (SPR)治疗成人脊髓损伤后肢体痉挛的疗效进行观察 ,并探讨手术前后诱发电位的变化对SPR的意义。方法 :对胸椎压缩性骨折致脊髓损伤 (30例 )及脊柱结核后期 (1 1例 )出现肢体痉挛的患者行L2～S1双侧节段开窗式椎板切除 ,将L2～S1的脊神经后根进行分束 ,电刺激仪测阈值 ,将阈值较低的神经束切断 ,神经根切断比例结合肌张力、肌力、体重及肌群功能进行量化 ,均 <30 %。术前 3d及术后 2 1d行诱发电位测定。结果 :经平均 5年随访 ,41例病人痉挛解除率 90 % ,功能改善率 75 %。术后皮层SEP波幅降低 ,感觉神经传导速度减慢 ,手术前后有显著差异 (P <0 0 1 )。结论 :选择性脊神经后根切断术能较有效地治疗成人脊髓损伤后肢体痉挛。手术前后诱发电位测定支持肌张力调节“大、小环路”理论 ,支持脊髓损伤后出现肢体痉挛的机制     

选择性脊神经后根切断术治疗顽固性疼痛的临床分析

目的 探讨选择性脊神经后根切断术治疗顽固性疼痛的临床效果及应用价值. 方法 应用选择性脊神经后根切断术治疗顽固性疼痛,通过将手术前后患者的疼痛表现、止痛药物应用数量、睡眠时间、疼痛视觉模拟评分(VAS)进行比较,从而分析该术式的临床效果. 结果 临床应用3例患者,其中1例随访11个月,顽固性疼痛消失,触压痛消失,止痛药物应用减少,睡眠时间及质量明显改善,VAS评分明显下降,临床止痛效果确切. 结论 对患有四肢或躯体顽固性神经性疼痛的患者,选择性脊神经后根切断术对缓解疼痛是有效的,具有一定的临床应用价值.     

SPR手术中椎板后移回植技术的应用

目的探讨在选择性脊神经后根切断术（ＳＰＲ）治疗痉挛性脑瘫中维护脊椎后柱结构稳定的新方法。方法在ＳＰＲ手术中采用椎板后移回植术治疗痉挛性脑瘫４６例。结果３４例随访６个月～２年４个月,优良率９７１％。结论椎板后移回植是维护脊椎后柱稳定的有效方法。     

Spinal deformity following selective dorsal rhizotomy

The authors performed a review of 79 patients treated by selective dorsal rhizotomy with laminoplasty, 78 of whom were ambulatory, to determine the prevalence of spinal deformities. The mean radiographic follow-up was 4.2 years, the mean clinical follow-up 5.8 years. Scoliosis (11 degrees -24 degrees ) was identified in 13 children, none of whom had a preexisting deformity. There were no significant differences between preoperative and follow-up thoracic kyphosis or lumbar lordosis, although there was a significant difference in lumbar lordosis between sitting and standing radiographs. No progressive or rigid hyperlordotic deformities were observed in the lumbar spine. Spondylolisthesis was identified in nine children (12%) (8/9 grade I), and one patient required an arthrodesis for pain. Spondylolisthesis was correlated with greater lumbar lordosis, stronger hip abductors, and increased popliteal femoral angles preoperatively, and with stronger hip flexors postoperatively. Back pain was identified in 4 of the 79 patients at last follow-up, 2 of whom had spondylolisthesis. As some cases of spondylolisthesis will remain asymptomatic, periodic radiographic follow-up is recommended.     

腰椎管成形在儿童选择性脊神经后根切断术中的应用及临床转归

[目的]探讨棘突椎板韧带复合体回植腰椎管成形在儿童选择性脊神经后根切断(SPR)术中的应用价值及术后转归。[方法]回顾性分析2007年7月～2009年12月本院腰椎SPR手术的脑瘫患儿36例68椎。手术时平均年龄6.5岁。椎管成形方法为棘突椎板棘上韧带复合体整块取出后纵劈开大,原位覆盖回植,丝线固定并重建棘上韧带连续性。术后随访患者症状和影像学评估腰椎稳定性、回植椎板骨融合及转归。[结果]随访平均32个月。术后患者均无腰痛。双下肢肌张力级别由术前平均2.2±0.6降至术后平均0.5±0.2,差异有统计学意义(P<0.05)。腰椎X线片19例未见明显异常;16例可见腰椎术后改变;12例腰椎屈伸位相术前和随访时比较未见明显变化。腰椎CT,椎管形态均基本完整,回植椎板融合率(85.3%),吸收率(61.8%)二者之间呈统计学负相关关系。2例腰椎MRI可见回植椎板部分缺失,硬膜囊无受压,棘上韧带连续。[结论]棘突椎板韧带复合体回植腰椎管成形应用于儿童SPR术可较好重建腰椎稳定性,随访2年以上有回植椎板吸收现象,但对腰椎发育无明显影响,残存椎板与周围软组织共同对椎管内神经起保护作用。     

Five-level one-piece laminoplasty for extensive tumors of the lumbar spine

The authors describe the surgical method and results of nonexpansive one-piece multivel laminoplasty of the whole lumbar spine, for microsurgical resection of extensive spinal tumors. This technique allows a very comfortable approach to the dura and intradural content, as well as a perfect replacement of the posterior spinal arch with supporting elements and an optimal reconstruction of the spinal anatomy. A nonexpansive whole lumbar one-piece laminoplasty was performed for resection of extensive multilevel lumbar tumors. The authors report an illustrative case of a patient who initially presented with a three-year history of numbness on both legs and progressive difficulty in walking. Two months before admission, he complained of bilateral sciatica and rectourinary dysfunction. A spinal magnetic resonance imaging (MRI) documented an intradural tumor extending from L2 to S1. The patient underwent a nonexpansive whole lumbar one-piece laminoplasty and microsurgical removal of the intradural lesion. The postoperative course was uneventful, the sensory disturbances and bilateral sciatica early recovered while rectourinary disturbance gradually improved up to a complete resolution at one year follow-up. The authors believe that multilevel laminoplasty rather than laminectomy is the technique of choice as a posterior procedure for extensive lumbar spinal tumors. With this technique, it is possible to obtain a very confortable approach to the dura and intradural content, as well as a perfect replacement of the posterior spinal arch with supporting elements and an optimal reconstruction of the normal spine. Moreover, this method prevents postoperative instability and deformity and avoids the so called post-laminectomy epidural membrane.     

撬拨椎板回植胸腰椎管成形术

目的：探讨与总结采用撬拨椎板回植椎管成形术在胸腰椎管手术应用中的安全、可靠和优越性。方法：自1996年4月－2000年5月应用特制骨凿和一定的技术路线进行撬拨椎板回植胸腰椎管成形术78例,其中胸椎腰 椎体压缩性骨折骨块移入椎管8例,腰椎管狭窄侧隐窝狭窄27例,腰椎间盘突出症38例,椎管肿瘤5例,均获得成功并取得很好的临床疗效。结果：本组全部病人均随访6个月以上（6个月－4年）,全部病例都在术后2－3个月达到良好的骨性愈合,未见骨不愈合、回植推板移入椎管或有移入倾向。未见截骨前缘过度增生对硬膜产生新的压迫等。无症状复发和胸腰椎不稳。结论：经78例手术应用证明,撬拨椎板回植管成形术在椎管手术应用中安全可靠、疗效好,具有避免椎管内粘连和瘢痕形成、恢复局部解剖和维持脊柱稳定的特点。     

腰椎管成形术对腰椎抗压强度的影响

腰椎管成形术是治疗腰椎滑滑脱症的新方法，为此，对腰椎管成形术进行了尸体脊柱生物力学实验研究。结果表明；腰椎管成形术后在前屈、后伸及左右侧弯时的载荷、位移和载荷－应变曲线均优于正常标本。     

The effect of multiple lesions in patients with ossification of the posterior longitudinal ligament of the cervical spine

PurposeOssification of the posterior longitudinal ligament of the cervical spine (cervical OPLL) is associated with the lesions at the thoracic and/or lumbar spine. Multiple spinal lesions cause additional neurological deficit, affecting the outcomes of cervical laminoplasty. This study aimed to clarify the effect of multiple lesions on the outcomes of cervical laminoplasty and to compare the results with data from patients without them.MethodsFrom April 1981 to October 2015, 201 patients underwent laminoplasty for cervical OPLL; however, 167 patients were followed for >2 years. Twenty-four patients underwent additional surgery for multiple lesions due to spinal stenosis. The pathologies of the lesions were assessed. The patients were divided into two groups: the thoracic and thoraco-lumbar group (T-group: 8 patients) and the lumbar group (L-group: 16 patients). One-hundred patients without an additional surgery served as the control group. The maximum Japanese Orthopaedic Association (JOA) score and the most recent score for recovery was compared between the multiple and control groups.ResultsThe maximum score and recovery rate and the score and recovery rate at the last follow-up in the multiple group were lower than those in the control group. There was no significant difference in the postoperative JOA score and recovery rate between the T-group and the L-group.ConclusionsNeurological recovery in patients with multiple lesions was poorer than in those without lesions. Therefore, special attention should be paid to cervical OPLL with multiple spinal lesions.     

Deformity of lumbar spine after selective dorsal rhizotomy for spastic cerebral palsy

To observe the effect of selective dorsal rhizotomy (SDR) on the deformity of the lumbar spine, a retrospective review was conducted from October 1992 to December 2002 on children who had undergone SDR in our department, and in whom preoperative and postoperative spine radiographs had been obtained. The angles of hyperlordolysis were measured. The study group comprised 219 patients, in which 61 cases were followed up and examined between May 2004 and February 2005. The mean age at surgery was 6.9 years (range 3-20 years), with a mean time to recent follow-up radiographs of 6.3 years (5-9 years). A total 219 children underwent laminectomy from L(2)-S(1). Scoliosis existed in one case, and two cases of L(5) spondylolysis were detected before surgery. One case presented lumbar hyperlordosis. After SDR, 10 cases showed distinctively abnormal walking posture of hyperlordolysis. Compared with the preoperative angle of hyperlordolysis, the angle was improved after the operation. Among them, four patients developed spondylolysis and spondylolisthesis (grade I). We also observed that one case developed lumbar kyphosis deformity. In conclusion, cerebral palsy patients may develop spinal deformity. Some cases showed distinctively abnormal walking posture of hyperlordolysis, and they developed spondylolysis and spondylolisthesis after surgery.     

Spinal deformity after selective dorsal rhizotomy in ambulatory patients with cerebral palsy

Thirty-four patients with ambulatory spastic diplegia (ages 10-19.8 years) who were part of a prospective study of selective dorsal rhizotomy (SDR) had standardized radiographs before and after SDR. Follow-up ranged from 5 to 11.6 years after surgery. Two different surgical approaches were used: laminectomy (14 patients) and laminoplasty (20 patients). Radiographs were measured for coronal and sagittal balance. Thirty patients had a spinal deformity at long-term follow-up compared with 10 patients before surgery. Seventeen patients (50%) developed lumbar hyperlordosis greater than 60 degrees. Six patients (18%) developed grade 1 spondylolisthesis, Scoliosis occurred de novo in eight patients (24%) and progressed by greater than 5 degrees in two patients with preoperative scoliosis. No significant differences were found between laminoplasty and laminectomy patients. None of the patients have undergone any surgical intervention for spinal deformity. There was a higher incidence of spinal deformity after SDR than in normals and an historical control population, which warrants clinical and radiographic long-term follow-up.     

微型钛板腰椎管成形术在腰椎管狭窄症的应用

目的 探讨采用微型钛板腰椎管成形术在治疗腰椎管疾病应用中的安全性及有效性。方法2000年6月～2004年9月，收治腰椎管狭窄症患者18例，男10例，女8例，年龄28～56岁。病程3个月～3年。其中发育性腰椎管狭窄11例，退变性腰椎管狭窄7例。均伴腰椎间盘突出：L5、S1 6例，L4,5,9例，L3,4 2例，L3～5 1例；伴侧隐窝狭窄13例。应用微型钛板腰椎管成形术治疗，半侧椎板回植3例，全椎板回植14例，2个节段椎板回植1例。结果患者术后获随访3个月～4年3个月，平均1年8个月。术后症状缓解，无并发症发生，3～9个月后骨性融合。CT随访示无回植椎板移入椎管或移位倾向，无截骨前缘过度增生对硬脊膜产生新的压迫等，无明显椎间退变及椎间不稳；椎管矢状径扩大1．8～5．6mm，平均3．2mm；横径扩大1．3～4．4mm，平均1．8mm，症状无复发。结论微型钛板腰椎管成形术在腰椎管狭窄手术应用中安全可靠、疗效好，椎管扩大明显，椎板重建可靠，恢复了局部解剖和维持脊柱稳定。     

Medium-term outcomes of C3�C6 laminoplasty for cervical myelopathy: a prospective study with a minimum 5-year follow-up

C3–6 laminoplasty preserving muscle insertions into the C7 spinous process is reportedly associated with a significantly decreased frequency of postoperative axial neck pain. However, no prospective study has reported medium-term outcomes of C3–6 laminoplasty. The purpose of this study was to elucidate medium-term outcomes after C3–6 laminoplasty. Subjects comprised 31 patients with cervical myelopathy who underwent C3–6 laminoplasty preserving all bilateral muscles attached to the C2 and C7 spinous processes and were followed for ≥5 years. Clinical and radiological data were prospectively collected. Neurological status was assessed using Japanese Orthopaedic Association (JOA) score. Axial neck pain was graded as severe, moderate or mild. Sagittal alignment of the cervical spine and progression of ossification of the posterior longitudinal ligament (OPLL) were assessed by comparing serial lateral radiographs. Mean JOA score improved significantly from 10.6 before surgery to 14.7 at the time of maximum recovery, and slightly declined to 14.3 at final follow-up. In six patients who developed late deterioration, these conditions were unrelated to the cervical spine. As of final follow-up, only one patient (3.2%) had complained of axial neck pain persisting for 5 years. Although progression of OPLL was found in 63.6% of patients, none had experienced neurological deterioration due to this progression. At final follow-up, sagittal alignment of the cervical spine was more lordotic than before surgery. Medium-term outcomes of C3–6 laminoplasty were satisfactory. Frequencies of persistent axial neck pain and loss of cervical lordosis after surgery remained significantly decreased for ≥5 years postoperatively.