单侧伤椎置钉治疗胸腰椎骨折39例临床观察

目的探讨单侧经伤椎短节段椎弓根螺钉内固定治疗胸腰椎骨折的临床疗效。方法自2010年2月—2012年8月,对39例胸腰段椎体骨折患者采用后路短节段内固定联合伤椎置钉的手术方法进行治疗,术前、术后随访摄片观察椎体高度有无丢失,内固定物有无松动。结果随访时间为6～18个月(平均为15.5个月)。于术前、术后观察对比伤椎椎体高度及Cobb角,未发现内固定物松动和断裂现象,术后患者恢复良好。结论经伤椎短节段椎弓根螺钉内固定能够增强脊柱的强度、稳定性好,同时可有效防止术后椎体高度的丢失和减少脊柱后凸畸形的发生率,是治疗胸腰椎骨折的一种切实有效的方法。     

Orthopedic treatment of vertebral compression fractures in osteoporosis

Vertebral compression fracture is the most common type of fractures in osteoporosis increasing the mortality and morbidity of the systemic disease. Adequate treatment of the vertebral compression fractures is always in the focus of the national and international spine meetings and one of the most innovative fields in the spine care is the surgical therapy of the osteoporotic spine. Here, the authors summarize the orthopedic treatment options for vertebral compression fractures based on a literature review and their own institutional experience.     

3T磁共振全脊柱成像技术应用

目的探讨磁共振全脊柱成像（Total Spine MR Imaging）技术在诊断脊柱与脊髓病变中的临床应用价值。方法采用西门子3.0T（MAGNETOM Trio A Tim System）超导磁共振成像系统,Tim线圈、自动进床及无缝拼接技术,对30例患者行全脊柱磁共振成像扫描及分析。结果 30例中除2例因图像粘合不理想,另28例均清晰、直观、完整的显示骨性脊柱、椎间盘及脊髓连续全脊柱MR图像,30例中磁共振成像显示脊柱转移14例、退变及突出8例、骨折及脱位6例、正常2例。结论磁共振全脊柱成像技术明显缩短了扫描时间,使图像质量得到了提高,解决了全脊柱磁共振成像的高分辨力难题,对脊柱、脊髓多发性、弥漫性病变的诊断有较大价值。     

颈椎损伤的早期诊断:CT与MRI的应用

[目的]探讨CT与MRI在颈椎损伤早期诊断中的应用价值。[方法]收集某院2009年1月～2011年1月颈椎损伤患者病例共30例,对其颈椎X线平片、CT及MRI资料进行回顾性分析,重点观察椎弓骨折及脊髓损伤。[结果]CT与MRI在颈椎损伤中各有优势,与普通X线片相比,CT在椎弓骨折的显示方面有明显优势,二者间有统计学差异;而在脊髓损伤的显示中,MRI则比CT更有优势。[结论CT与MRI的应用,可以明显提高颈椎损伤的早期诊断的准确率,为治疗提供更多的信息。     

Spine bone mineral density and vertebral body height are altered by alcohol consumption in growing male and female rats.

Alcohol, consumed for extended periods by growing male and female rats, impairs osteogenesis and reduces bone size and mass. The skeletal sites of experimental animals commonly chosen for an evaluation of bone mechanical characteristics and architectural properties, bone matrix gene expression, tissue concentrations of growth factors, and bone mineral density (BMD) have been the tibiae and femora. Far less attention has been focused on the spine and the effects of alcohol on vertebral BMD and vertebral body height. Fifteen male and 15 female Sprague-Dawley rats (aged 30 days) were divided into three groups: an alcohol-fed group, matched to a pair-fed non-alcohol isocaloric-fed control group with animals of the same sex, and an ad libitum-fed control group. Alcohol-fed animals received a Lieber-DeCarli liquid diet containing 36% of caloric intake as alcohol; isocaloric pair-fed rats received the same diet without alcohol. After 45 days of feeding, the lumbar spine was removed. The fourth lumbar vertebra from each spine was dissected, and the vertebral body height was measured. Lumbar vertebral body height was significantly reduced by alcohol consumption in both male and female rats compared with findings for either control group. Cancellous and cortical BMD of the vertebral body was determined by peripheral quantitative computed tomography (pQCT). Male and female rats (aged 75 days) in the ad libitum-fed group had similar vertebral body cortical and cancellous BMD, with cortical BMD being greater than cancellous BMD. Lumbar vertebral body cancellous and cortical BMD declined for both male and female rats in response to alcohol consumption for 45 days compared with findings for either control group. More BMD loss occurred from cancellous than from cortical bone in both sexes after chronic alcohol consumption. Chronic alcohol consumption by growing rats results in vertebral growth reduction and vertebral osteopenia.     

不同方法治疗骨质疏松性脊柱骨折的临床对比研究

目的 对比分析不同方法治疗骨质疏松性脊柱骨折的临床效果,期许为该病的临床研究做出贡献.方法 将我院在2012年3月-2013年4月收治的30例骨质疏松性脊柱骨折患者作为研究对象,并将其随机分为观察组和对照组,每组各15例患者,观察组采用椎体后凸成形术治疗,对照组采用保守治疗,并对比分析两组患者的临床治疗效果.结果 观察组的临床治疗效果明显优于对照组,且差异具有统计学意义（P＜0.05）.结论 椎体后凸成形术治疗骨质疏松性脊柱骨折的临床效果十分显著,且创伤小、并发症少,利于骨质疏松性脊柱骨折患者的康复,值得推广应用.     

全景矩阵成像技术MR全脊柱成像的临床应用

目的：研究全号矩阵成像（Total Image Matrix）技术磁共振全脊柱成像在诊断脊柱及脊髓病变的临床应用价值。方法：采用西门子Avanto 1．5T超导磁共振成像系统,Tim线圈、自动移床及无缝拼接技术．对75例可疑脊柱及脊髓病变者行全脊柱成像,并对病变局部行高分辨力成像。结果：75例均清晰、直观、完整的显示椎管内全段脊髓、全部脊椎及周围韧带的连续全脊柱MR图像,75例中MRI全脊柱成像显示15例正常,41例脊柱病变,19例脊髓病变。结论：全景矩阵成像技术MR全脊柱成像明显缩短了扫描时间。图像质量好,定位、定性准确性高,解决了大范围、高分辨力的脊柱成像难题,对脊枉、脊髓多发性、弥漫性病变的诊断有较大价值。     

磁共振全脊柱成像技术在脊柱疾病中的临床应用

目的：研究磁共振全脊柱成像对脊柱病变中的临床价值。方法：搜集42例脊柱病变临床资料,进行全脊柱扫描成像,对MRI图像进行回顾性分析。结果：全部病例均完整显示全段脊柱的椎体、椎管、脊髓及周围韧带等结构。其中,椎间盘突出14例,黄韧带肥厚6例,脊柱外伤9例,脊髓空洞症5例,转移瘤5例,脊柱结核2例,脊柱畸形1例。结论：磁共振全脊柱成像技术可在一次检查过程中显示全段脊柱、脊髓影像,对多发病变的寻找和病变的准确定位具有重要作用,具有广泛的临床应用价值。     

磁共振全脊柱成像技术与临床应用

目的:探讨磁共振全脊柱成像特点与在诊断脊柱、脊髓病变方面的临床价值.方法:采用PhilipsAchieva 1.5T双梯度超导磁共振成像系统,SENSE-Spine线圈,自动移床和无缝拼接技术,对52例临床疑是脊柱及脊髓病变者行全脊柱成像,并对病变局部行高分辨力成像.结果:52例患者均获得了清晰、直观、完整的显示椎管内全段脊髓、脊椎及周围韧带的连续全脊柱MR图像,MR全脊柱成像显示5例正常,30例脊柱病变,17例脊髓病变.结论:MR全脊柱成像明显缩短了扫描时间,图像质量好,定位、定性准确性高,解决了大范围、高分辨力的脊柱成像难题,对脊柱、脊髓多发性、弥漫性病变的诊断有较大价值.     

经伤椎置钉用于脊柱骨折患者治疗中的研究进展

脊柱骨折在临床中的发病率较高,以骨折部位的不同可将脊柱骨折分为颈椎骨折、腰椎骨折、胸椎骨折以及胸腰椎段脊柱骨折等类型,其中胸腰椎段脊柱骨折相对比较常见,骨折后患者可出现肿胀、压痛以及运动功能障碍等临床症状和表现。目前针对脊柱骨折的治疗以手术为主,以往跨伤椎切开复位内固定手术是治疗该疾病的常用方法,能够促进其胸腰椎活动能力的恢复,但术后内固定螺钉断裂、松动等并发症风险较高,且远期矫正度易丢失,因此寻找更安全有效的治疗方法十分重要。近年来医学技术不断发展,经伤椎置钉技术因其术后并发症发生率低,安全性较高的优势在临床中的应用越来越多,本文将针对脊柱骨折患者治疗中经伤椎置钉技术的应用情况进行综述。     

寰枢椎椎弓根钉内固定重建上颈椎不稳

目的 探讨寰枢椎椎弓根钉内固定融合重建上颈椎不稳的临床疗效.方法 采用寰枢椎椎弓根钉内固定自体髂骨植骨治疗上颈椎不稳患者21例,其中Ⅱ型齿状突骨折13例,齿状突不连5例,横韧带损伤3例.在寰枢椎后弓间植骨融合,使寰枢椎复合体得到稳定.结果 共置入84枚螺钉,术中2枚螺钉穿破寰椎左侧椎弓根外侧壁,未发生脊髓、椎动脉损伤.所有患者X线片示寰椎完全复位,枢椎齿状突骨折处复位良好.CT片示螺钉与椎动脉及脊髓位置关系良好.按JOA评分标准,优15例,良3例,可2例,差1例,优良率85.71%(18/21).17例患者获得随访,随访时间12～26(12.83±4.23)个月,均获得骨性融合,未发现钉板断裂.结论 寰枢椎椎弓根螺钉结合钉板系统固定重建上颈椎不稳能显著增强寰枢椎间生物力学稳定性,植骨融合率高,该术式在寰枢椎融合术中具有较高的推广应用价值.     

The association between oral contraceptive use, bone mineral density and fractures in women aged 50-80 years

Background

The associations between oral contraceptive (OC) use, bone mineral density (BMD) and the risk of fractures remain controversial.

Study Design

A cross-sectional study of 491 women aged 50–80 years was performed. We assessed OC use and fractures by questionnaire, and BMD and vertebral deformity by dual-energy x-ray absorptiometry.

Results

Ever use of OC was associated with significantly higher BMD at the total body (6%, p<.001) and spine (4%; p=.05) (but not hip) after adjustment for confounders. There was also a significant association between duration of OC use and total body and spine BMD. Use of OCs for 5–10 years was associated with reduced vertebral deformity (adjusted odds ratio 0.46, 95% confidence interval 0.22–0.94).

Conclusions

Oral contraceptive use and duration were associated with higher total body and spine BMD and a consistent reduction in vertebral deformities, although most associations did not reach significance.     

磁共振脊髓水成像在椎管病变诊断中的应用

目的：探讨磁共振脊髓水成像（MR myelography,MRM）在椎管病变诊断中的临床应用价值。方法：采用西门子Avanto 1．5T超导磁共振成像系统,利用Tim线圈、自动移床及无缝拼接技术对85例疑似脊柱及脊髓病变者分别行常规平扫和MRM．三维图像经最大强度投影及立体透视技术后处理后多角度观察。结果：MRM可清晰显示椎管内“造影柱”的形态。椎管内外不同病变对造影柱造成的压迫各有特征：硬膜外病变会导致患侧造影柱狭窄;硬膜下病变会造成患侧造影柱扩大．脊髓向对侧移位;髓内病变会造成造影柱均匀变窄。结论：MRM具有无创伤、无辐射、速度快、无需对比剂、患者易接受的特点,对各种病变所导致的椎管改变可清晰显示,通过对造影柱形态的观察可对病变进行定位或定性诊断：与常规MRI图像结合可荻得全面、直观的病变信息,可取代X线脊髓造影和CT脊髓造影。     

胸腰椎前路钉棒系统的临床应用

目的探讨应用新的脊椎前路钉棒系统进行胸腰段脊柱前路手术的效果。方法应用脊椎前路钉棒系统器械对12例脊柱疾病患者进行前路手术,其中胸腰段椎体爆裂型骨折6例均合并双下肢不全瘫,胸椎结核2例,腰椎结核3例,腰椎肿瘤1例。结果本组12例病人随访时间最长的3年,最短的近6个月。复位满意,植骨已融合,疼痛消失,无断钉松动等并发症,合并脊髓损伤的有不同程度恢复,结核恢复得比较好,外伤急性损伤稍差。结论脊柱前路钉棒内固定系统用于脊柱前路手术固定可靠,操作简单易行, 效果满意。     

后路单节段椎弓根钉内固定术治疗胸腰椎骨折

目的 探讨经后路单节段椎弓根钉内固定术治疗胸腰椎骨折的临床疗效.方法 经后路对16例胸腰椎骨折患者行切开复位单节段椎弓根钉内固定术,并同时行后外侧植骨术,其中9例行椎板切除椎管探查.术后神经功能恢复按Frankel分级评定标准,采用Suk标准评估术后植骨融合情况,术后腰痛按Denis分级评估.结果 随访8～24个月,平均(13.0±3.4)个月.伤椎高度恢复满意,与上下方椎体相应高度均值相比矫正率为30.8%,后凸畸形显著矫正,植骨均融合,无断钉、断棒及螺钉松动.9例有神经症状者术后Frankel分级均有1级以上恢复.随访期间腰痛按Denis分级评估:P114例,P22例.结论 对于合适的胸腰椎骨折患者,切开复位后路单节段椎弓根钉内固定术是一种安全有效的治疗方法.     

Osteoporosis with vertebral fractures associated with pregnancy and lactation

Three cases of young women who developed severe vertebral osteoporosis after pregnancy and during lactation are described. These patients shared several features: a low-calcium diet during most of their lives, very-low body weight in two patients, and a positive family history of osteoporosis in two patients. Initial studies disclosed vertebral fractures, severely diminished bone mineral density of the spine (Z score = -3.3 to -4.1), and a less severely affected bone mineral density of the hip (Z score = -1.6 to -2.3). During the prolonged follow-up of these patients, treated with oral biphosphonates, vitamin D, and calcium, an improved clinical response with a marked recovery of spine bone mineral density was observed. Poor general nutrition, low calcium intake, and a positive family history of osteoporosis appear to be strong risk factors for pregnancy- and lactation-associated osteoporosis. Although the mechanism of action is uncertain, calcium, vitamin D, and antiresorptive agents may have been beneficial in the treatment of this severe disorder.     

Prevalence of osteoporosis in postmenopausal women in family practice

OBJECTIVE: To assess the prevalence of osteopenia, osteoporosis and severe vertebral deformities in general practice. DESIGN: Cross-sectional study. METHODS: Of a randomly selected group of 712 women aged 55 to 84 years in a general practice in Noordwijk, the Netherlands, 449 (63%) participated in a study in 1996, in which Dual Energy X-ray Absorptiometry (DXA) of the femoral neck was performed: in 428 women vertebral morphometry of lateral radiographs of the spine was also done. The World Health Organization definitions of osteopenia and osteoporosis were used. RESULTS: The mean bone mineral density (BMD) was 0.866 g/cm2 (SD: 0.135). With increasing age the BMD decreased statistically significantly by 0.0073 g/cm2/year. There were 189 women with osteopenia (42%). 33 (7%) with osteoporosis and 44 (10%) with one or more severe vertebral deformities. A significantly lower mean BMD was found in those with severe vertebral deformities than in those without.     

椎旁肌间隙入路椎弓根螺钉内固定术治疗胸腰段脊柱骨折的疗效分析

目的 观察分析胸腰段脊柱骨折患者采用椎旁肌间隙入路椎弓根螺钉内固定术治疗的临床疗效.方法 50例胸腰椎骨折患者随机分成观察组和对照组各25例,观察组患者使用椎旁肌间隙入路椎弓根螺钉内固定术进行治疗,对照组使用传统方法剥离椎旁肌后入路椎弓根螺钉内固定术进行治疗.观察患者临床手术指标、术后2周与6个月时的VAS疼痛评分、术后下地前及随访时的伤椎椎体前缘高度.结果 观察组临床手术指标优于对照组,术后VAS疼痛评分低于对照组,差异均有统计学意义(P<0.05);术后,组间伤椎椎体前缘高度差异没有统计学意义(P>0.05).结论 椎旁肌间隙入路椎弓根螺钉内固定术比传统方法手术时间更短,术中出血更少,患者恢复更快,不仅能起到较好的复位效果,还能明显降低患者的疼痛.     

中上胸椎经肋椎关节内固定的解剖学研究

目的测量中上胸椎经肋椎关节固定和经椎弓根固定的相关数据,并进行对比,为其临床应用提供参考资料。方法 16具成人胸椎标本,选择T1-T8共128个椎体,测量每个椎体经肋椎关节和经椎弓根固定通路的长度,e角(肋椎关节和椎弓根轴线分别与椎体矢状轴的夹角)及f角(肋椎关节轴线与椎体水平面的夹角),所得数据进行统计学分析。结果相同节段经肋椎关节固定的钉道长度和e角>经椎弓根,不同肋椎关节f角的变化不大。结论中上胸椎相同节段经肋椎关节固定可获得的钉道长度和内倾角>经椎弓根固定,f角提示经肋椎关节固定的进钉方向应基本平行于相应椎体的水平面。     

128层螺旋CT诊断骨质疏松性椎体压缩骨折的优势

目的探讨128排螺旋CT多种重建方法对骨质疏松性椎体压缩骨折的诊断价值。方法收集临床诊断为原发性骨质疏松症患者56例进行128排螺旋CT腰椎容积扫描,对扫描图像采用三维重建、矢状位重建、曲面冠状位重建和薄层横断面重建等方法对椎体骨折情况进行评价,并与X线和MRI（磁共振成像）诊断结果对照,对骨质疏松程度进行初步分级。结果 56例72个椎体压缩骨折,有骨折线椎体65个,椎管狭窄4个,5个椎体附件骨折,1个椎体神经孔狭窄,5个椎体发生滑脱;128排螺旋CT多种重建方法联合应用,能准确全面诊断椎体骨折情况,对椎管狭窄及附件骨折显示准确度明显高于普通X线片及MRI;56例经过128排螺旋CT图像测量评估骨质疏松程度分别为轻度28例,中度19例,重度9例。结论 128层螺旋CT对椎体压缩骨折程度的判断较以往检查方法有明显优势,并能初步判断骨质疏松程度。