颈椎软骨终板钙化与颈椎间盘退变和椎体骨赘形成的关系

目的：研究颈椎软骨终板钙化与颈椎间盘退变和颈椎椎体骨赘形成的关系。方法：应用组织学方法观察颈前路环锯手术切下的18例脊髓型颈椎病和4例颈椎过伸性损伤致颈椎间盘突出患者的颈椎间盘及相邻的上下椎体标本,研究不同退变程度颈椎间盘软骨终板和椎间盘的形态学变化及椎体骨赘形成过程。结果：退变程度较轻或基本正常的颈椎间盘软骨终板结构良好,潮标清晰,退变程度较重的颈椎间盘软骨终板发生明显纤维化,潮标前移,钙化软骨和软骨下骨板增厚,退变颈椎间盘周边软骨终板潮标明显前移,钙化和骨化层增厚,形成突向外侧的椎体边缘的骨赘。结论：颈椎软骨终板的不断钙化和骨化导致颈椎间盘营养发生障碍可能是启动颈椎间盘退变的关键因素,退变椎体周边软骨终板的不断钙化和骨化是椎体骨赘形成的根本原因。     

切除与漂浮后纵韧带在脊髓型颈椎病前路减压术中的疗效对比

目的比较后纵韧带切除与漂浮在单间隙脊髓型颈椎病前路减压术中的疗效。方法对93例行前路减压植骨内固定治疗的单间隙脊髓型颈椎病患者资料进行分析。其中脊髓明显压迫41例(A组),伴有椎体后缘骨赘形成或椎间盘脱出;椎间盘突出压迫为主;无椎体后缘骨赘形成52例(B组)。按照JOA评分分别比较后纵韧带切除与漂浮术后症状的改善率。结果平均随访16个月,A组中行后纵韧带切除与漂浮平均改善率分别为77%和67%,B组分别为75%和74%。结论对于椎体后缘骨赘形成或椎间盘脱出病例切除韧带术疗效优于漂浮术,对于椎间盘突出压迫为主而无椎体后缘骨赘形成者,两者疗效无明显差异。     

应用Zero-p颈椎融合器cage治疗颈椎外伤合并脊髓型颈椎病

脊髓型颈椎病(CSM)指颈椎间盘向后突出、椎体后缘骨赘、甚至黄韧带钙化压迫脊髓而产生的一系列神经症状。笔者自2009年12月~2010年12月应用AO公司Zero-p颈椎cage手术治疗颈椎外伤伴脊髓型颈椎病20例,术后神经功能均恢复良好,临床效果满意。     

椎间盘及部分椎体切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘突出伴椎体后缘骨赘

目的 评价颈椎椎间盘及相邻椎体部分切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘退变突出伴相邻椎体后缘骨赘的疗效. 方法 应用颈椎椎间盘及相邻椎体部分切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘退变突出伴相邻椎体后缘骨赘22例.取颈椎前路手术切口,术中仅切除突出的椎间盘及相邻椎体的1/3～ 1/2,使脊髓得到彻底的减压.再用填满碎骨的钛网植于骨缺损处加用钛板螺丝钉内固定,固定范围仅限于相邻椎体.术前和术后通过神经功能JOA评分、颈部轴性症状、颈椎动态侧位片和颈椎MRI比较临床疗效. 结果 均获随访,平均15(6 ～24)个月,术后JOA评分优良率86.4％,颈部轴性症状减轻,脊髓功能明显得到恢复.颈椎活动度良好.X线检查见钛网植骨及钛板内固定良好,未见不稳现象.MRI示颈髓压迫解除. 结论 颈椎椎间盘及相邻椎体部分切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘突出伴相邻椎体骨赘效果显著,可最大限度地保留颈椎节段的活动度.     

后纵韧带切除及潜行减压在脊髓型颈椎病前路手术中的价值

目的评价退变增厚的后纵韧带切除及潜行切除椎体后缘骨赘减压对脊髓型颈椎病（CSM）前路手术疗效的影响。方法同时伴有椎体后缘骨赘增生和后纵韧带退变增厚的脊髓型颈椎病40例，予前路切除退变后纵韧带、潜行骨赘减压，并植骨融合内固定。随访6～36个月，平均14．5月。据JOA评分系统对脊髓功能恢复进行评定比较。结果术前JOA评分：3～13分，平均10．3分。术后6月：11.5～17分，平均15．7分，RIS：32％～100％（76％±20％）。术前与术后6月比较有显著性差异（P〈0．01）。结论切除退变增厚的后纵韧带及潜行切除椎体后缘骨赘减乐可使受压脊髓得到最大限度的减压，可显著提高CSM前路手术的疗效。     

人工颈椎间盘置换术适应证及疗效探讨

目的 依据影像学评价标准及颈前路手术减压方式的选择探讨颈椎人工椎间盘置换手术的适应证.方法 回顾性分析2008年1月至2009年7月具有完整资料的175例行颈前路手术的颈椎病及颈椎间盘突出症病例,行融合手术145例,人工椎间盘置换术30例.依据术前影像学评价标准对患者进行不同手术:(1)椎间隙减压融合术;(2)游离型椎间盘突出超过相邻椎体后缘高度1/2者,先通过椎间隙摘除游离的间盘组织碎块,再通过椎体次全切除确认是否将游离的间盘组织碎块完全摘除;(3)椎体次全切减压融合术;(4)ProDisc-C人工颈椎间盘置换术.单节段病变的脊髓型颈椎病按融合术及人工椎间盘置换术分组,比较两组日本矫形外科协会(Japanese Orthopaedic Association,JOA)脊髓功能评分,评价两种手术方式疗效;统计并分析术前和术后1、3、6、12个月人工椎间盘置换节段运动范围.结果 单纯椎间盘突出、轻度椎间盘钙化、椎体后缘有较小骨赘形成的颈椎病可以通过椎间隙达到彻底减压行人工椎间盘置换术.椎体后缘有巨大骨赘形成、严重椎间盘钙化、相应椎间隙严重狭窄或融合、后纵韧带骨化、广泛的椎管狭窄需行椎体次全切除才能达到彻底减压.JOA评分平均改善率:融合术者为66.05%,人工椎间盘置换术者为67.13%,差异无统计学意义;人工椎间盘置换节段术后1、3、6、12个月运动范围与术前相比差异无统计学意义.结论 颈椎病及颈椎间盘突出症,只要能通过前路椎间隙达到彻底减压就可行人工椎间盘置换术.单节段脊髓型颈椎病行人工椎间盘置换术和前路植骨融合内固定术近期手术疗效均良好,但人工椎间盘置换术使置换节段的运动范围得到保留.     

82例脊髓型颈椎病病人的麻醉和气道管理

脊髓型颈椎病是以椎间盘退变为基础 ,在一定的外力作用下颈椎间盘逐渐突出 ,相邻椎体后缘退变而逐渐形成骨赘 ,导致该节段脊髓神经根压迫并脊髓血循环障碍 ,给气管内插管和呼吸循环管理带来困难。我院自 1983年以来 ,采用经鼻插管静吸复合麻醉下施行颈椎前路减压植骨融合术82例 ,报告如下。资料与方法一般资料　本组 82例 ,男 6 8例 ,女 14例 ,年龄 38～ 76岁。颈肩部有隐痛或剧痛者 6 6例 ,受损害神经分布区感觉减退 6 7例 ,四肢无力和肌萎缩者 6 9例 ,肌张力增高 16例 ,腱反射亢进 16例 ,Ｈｏｆｆｍａｎｎ阳性者 17例 ,踝髌阵挛者 16例。…     

前后路联合手术治疗脊髓型颈椎病的适应证探讨

目的：探讨前后路联合手术在脊髓型颈椎病中的适应证。方法：对87例脊髓型颈椎病合并多节段颈椎管狭窄、后纵韧带钙化（0PLL）,合并颈椎黄韧带肥厚或黄韧带钙化症,多节段颈椎间盘后突压迫或椎体后缘巨大骨赘者,颈椎退变性节段不稳伴颈椎、脊柱后凸畸形患者行前后路联合减压、植骨融合、内固定手术。结果：87例患者随访10～24个月（平均12,6个月）,植骨均已融合,内固定物无松动、断裂。根据日本矫形外科学会（JOA）评分标准,除5例高位完全截瘫患者未恢复外,其余82例患者平均JOA评分由术前8．9分（5～11分）增加到13,2分（8～17分）,评分提高3～6分。术后短期并发症均逐渐恢复;4例食管瘘患者经手术修补也顺利愈合。结论：前后联合手术减压充分,能较好重建颈椎稳定性。适用于脊髓型颈椎病合并多节段颈椎管狭窄、后纵韧带钙化（0PLL）,合并颈椎黄韧带肥厚或黄韧带钙化症,多节段颈椎间盘后突压迫或椎体后缘巨大骨赘者,颈椎退变性节段不稳伴颈椎后凸畸形患者等。     

颈椎病突出椎间盘组织炎性反应特性的研究

目的：探讨颈椎病发生中突出颈椎间盘组织的炎症反应特性。方法：取31例脊髓型颈椎病患者的35个突出的颈椎间盘标本和3个成年人的7个正常颈椎间盘标本，将每个标本分为2份，1份作组织学检查，观察有无炎细胞浸润，1份用生物化学方法测定其中IL－1α、IL－6和TNF－α的含量。结果：35个突出颈椎间盘中，18个（51．4％）在边缘区域有大量炎细胞浸润，其余17个（48．6％）未见炎细胞浸润，对照组未见炎细胞浸润；35个突出颈椎间盘组织中IL－1α、IL－6和NTF－α含量明显高于正常椎间盘。结论：颈椎病患者突出椎间盘组织具有炎症反应特性，炎症反应可能在颈椎间盘退变和颈椎病的发生发展中起重要作用。     

颈椎后纵韧带增殖细胞核抗原定位研究

目的 通过对颈椎后纵韧带增殖细胞核抗原（PCNA）免疫组化的定位研究来探讨后纵韧带肥厚的发生机制。方法 前路减压术分别从23例颈椎间盘突出症（CDH）,脊髓型颈椎病（CSM）,颈椎创伤（CVT）患者不同部位的后纵韧带切取部份组织作HE染色及PCNA单克隆抗体免疫组化染色。结果 5例颈椎间盘突出症（CDH）患者在运动终板处后纵韧带细胞均有PCNA高表达,在椎间盘及椎体处13例脊髓型颈椎病（CSM）患者中只有2例出现PCNA高表达,5例颈椎创伤（CVT）中2例出现PCNA高表达。结论 后纵韧带肥厚与髓核炎性刺激压迫及创伤后的炎性反应有关。     

VEGF在30例脊髓型颈椎病椎间盘组织中的表达及意义

目的探讨血管内皮生长因子(VEGF)在突出颈椎间盘组织中的表达及意义。方法将30例来源于脊髓型颈椎病患者手术中取得的椎间盘组织和10例来源于颈椎骨折前路手术所获得的椎间盘组织作VEGF免疫组化检测,并做对照比较分析。结果对照组中椎间盘组织表达均为阴性;突出椎间盘组织表达阳性率为76.7%,有显著性差异(P<0.01)。结论突出的颈椎间盘组织可以诱导产生VEGF,VEGF可能通过促进新生血管的发生、发展,在突出颈椎间盘退变中起重要作用。     

颈椎病患者突出椎间盘周围的炎症反应及临床意义

目的：观察颈椎病患者突出椎间盘周同组织的病理表现，并探讨其临床意义。方法：79例颈椎病患者手术切除100个突出的椎间盘；取出间盘周围的绀织进行HE染色及免疫绀化染色。将染色结果结合其临床表现、影像学资料进行分析。结果：45个(45％)突出间盘周围的组织内可见血管增生、炎症细胞浸润：炎症组与无炎症组患者在病程、术后脊髓功能改善方面存在显著性差异；炎症反应与颈椎不稳定之间存在显著相关性。结论：(1)部分颈椎病患者突出椎间盘周围组织内存在慢性炎症反应，炎症浸润细胞多为单核-巨噬细胞及淋巴细胞；(2)颈椎不稳定可能是造成突出椎间盘周围组织内炎症反应的原因之一；(3)慢性炎症因素可能参与了颈椎病的发病。     

Herniated and spondylotic intervertebral discs of the human cervical spine: histological and immunohistological findings in 500 en bloc surgical samples. Laboratory investigation

OBJECT: In this paper the authors' goal was to identify histological and immunohistochemical differences between cervical disc hemrniation and spondylosis. METHODS: A total of 500 cervical intervertebral discs were excised from 364 patients: 198 patients with disc herniation and 166 patients with spondylosis. We examined en bloc samples of endplate-ligament-disc complexes. Types of herniation and graded degrees of disc degeneration on MR images were examined histologically and immunohistochemically. RESULTS: The herniated discs showed granulation tissue, newly developed blood vessels, and massive infiltration of CD68-positive macrophages, which surrounded the herniated tissue mainly in the ruptured outer layer of the anulus fibrosus. The vascular invasion was most significant in uncontained (extruded)-type herniated discs. Chondrocytes positive for matrix metalloproteinase (MMP)-3, tumor necrosis factor (TNF)-alpha, basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF) were abundant in both herniated and spondylotic discs. Free nerve fibers, positive for nerve growth factor (NGF), neurofilament 68, growth-associated protein (GAP)-43, and substance P, were strongly apparent in and around the outer layer of uncontained (extruded)-type herniated discs, with enhanced expression of NGF. The authors observed that herniated discs showed more advanced degeneration in the outer layer of the anulus fibrosus around the granulation tissue than spondylotic discs. On the other hand, spondylotic discs showed more advanced degeneration in the cartilaginous endplate and inner layer of the anulus fibrosus than herniated discs. Spondylotic discs also had thicker bony endplates and expressed TNFalpha and MMP-3 more diffusely than herniated discs, especially in the inner layer of the anulus fibrosus. CONCLUSIONS: The authors' results indicate that herniated and spondylotic intervertebral discs undergo different degenerative processes. It is likely that TNFa, MMP-3, bFGF, and VEGF expression is upregulated via the herniated mass in the herniated intervertebral discs, but by nutritional impairment in the spondylotic discs. Macrophage accumulation around newly formed blood vessels in the herniated disc tissues seemed to be regulated by MMP-3 and TNFalpha expression, and both herniated and spondylotic discs exhibited marked neoangiogenesis associated with increased bFGF and VEGF expression. Nerve fibers were associated with NGF overexpression in the outer layer of the anulus fibrosus as well as in endothelial cells of the small blood vessels.     

颈椎后方韧带复合体也许是多节段颈椎病后路手术的新思路

颈椎病是影响国人乃至全人类最常见的脊柱退行性疾患之一,颈椎病会给病人带来极大的不适和生活困扰。后路减压手术是治疗颈椎病,尤其是多节段颈椎病变最常用的手术方式。然而,后路手术需将颈椎棘突和附着在其上的棘上、棘间韧带部分或完全切除,从而破坏了颈椎后方韧带复合体的功能,术后病人易出现颈椎反曲、鹅颈畸形、颈椎失稳,甚至出现迟发性脊髓神经受压。所以,近年来越来越多的研究开始集中于避免破坏颈椎后方韧带复合体,国内外学者从集中术式改良和手术入路改良两方面进行了一些研究,均直接或间接的证明了保留颈椎后方韧带复合体的手术方式具有更好的治疗效果。故本文就近年来保留颈椎后方韧带复合体的术式研究作一综述,希望能为未来多节段退变性颈椎病后路的治疗提供一个新的思路。     

颈椎间盘退变中血管浸润现象的研究

目的探讨颈椎间盘退变中血管浸润现象的规律。方法34例病人均来自本院骨科的需手术治疗的住院病人,其中脊髓型颈椎病16例,单纯颈椎间盘突出症18例,所有病人术前均行MRI以判定颈椎间盘退变的分级,术后椎间盘标本常规脱水、浸蜡、包埋,制作蜡块。常规切片,HE染色,普通光镜下观察血管浸润现象。结果在57个椎间盘标本中,共检出21例有血管浸润,其中颈椎间盘突出症中共检出13个有血管浸润的椎间盘,脊髓型颈椎病共检出8个有血管浸润的椎间盘。病程在5个月以内或MRI分级为Ⅰ级和Ⅱ级的患者其椎间盘血管浸润率高。结论单纯颈椎间盘突出症患者其椎间盘血管浸润率高于脊髓型颈椎病患者。血管浸润大多出现于病程及椎间盘退变早期,是椎间盘自身修复的一种方式。     

Is there any relationship between proinflammatory mediator levels in disc material and myelopathy with cervical disc herniation and spondylosis? A non-randomized,prospective clinical study

The proinflammatory mediator (PIM) levels were assessed in surgically removed samples of herniated cervical intervertebral discs. The objective of this study was to investigate if there is a correlation between the levels of PIMs in disc material and myelopathy associated with cervical intervertebral disc herniation and spondylosis. The role of proinflammatory mediators in the degeneration of intervertebral disc and the inflammatory effects of disc herniations on radicular pain has been previously published. However, the possible relationship between PIMs and myelopathy related to cervical disc herniation and spondylosis has not been investigated before. Thirty-two patients undergoing surgery for cervical disc herniation and spondylosis were investigated. Surgically obtained disc materials, stored at 70 degrees C, were classified into two groups: cervical disc herniation alone or with myelopathy. Biochemical preparation and solid phase enzyme amplified sensitivity immunoassay (ELISIA) analysis of the samples were performed to assess the concentration of mediators in the samples. Very similar values of interleukin-6 were found in both groups whereas the concentrations of mediators were significantly higher in myelopathy group. This study has demonstrated that PIMs are involved in cervical intervertebral disc degeneration with higher concentrations in the samples associated with myelopathy.     

Histopathological studies of the osteophytes and ossification of the posterior longitudinal ligament (OPLL) in the cervical spine

To obtain information on ossification around the vertebral body of the cervical spine, we carried out histopathological investigation on 30 autopsy cases. The results were as follows; Intervertebral discs were untouched, anterior osteophytes developed along the anterior longitudinal ligament and they corresponded to anterior spur in spondylosis deformans. Posterior osteophytes around the posterior edges of vertebral body resulted in intervertebral insufficiency, and corresponded to hypertrophic spur in osteochondrosis. Histopathological findings of hyperostotic anterior osteophytes were similar to anterior osteophytes, but in the former there were advanced osteophyte formations. In OPLL of the segmental type, intervertebral discs were degenerated, and ossified mass did not involve the posterior longitudinal ligament of the parts of discs. With regard to morphological appearance and the tendency of increasing ossification, OPLL of the continuous type was similar to hyperostotic anterior osteophytes, without involvement of intervertebral disc. OPLL of the distinctly continuous type was differentiated from that of the segmental type.