颈椎椎间隙不同程度变窄与椎间孔变化的相关性研究

目的研究颈椎椎间隙不同程度变窄与椎间孔大小变化的关系。方法计算机辅助模拟测量15具国人颈椎解剖标本的C_(4、5),C_(5、6),C_(6、7)椎间孔的面积及在椎间隙狭窄1、2、3 mm时椎间孔面积的变化。结果在椎间隙变窄1、2、3 mm时,椎间孔的面积分别减少20%～30%、30%～40%、35%～45%。结论不同程度的椎间隙变窄导致的椎间孔面积的减少在统计学上有显著性差异,椎间孔的大小直接与椎间隙的高度有关,椎间盘退变狭窄所致的椎间孔内神经根的压迫不应被忽视。     

颈椎前路减压椎间融合器置入对椎间孔孔径的影响

目的 :探讨颈椎前路减压椎间融合器置入对椎间孔孔径的影响。方法 :回顾性分析2016年10月~2017年4月在我院行单节段颈椎前路减压椎间融合器置入术的29例神经根型或脊髓型颈椎病患者,其中男18例,女11例;年龄40~66岁(54.2±6.9岁);手术节段:C3/4 3例,C4/5 9例,C5/6 17例。将所有患者的术前、术后颈椎CT平扫数据导入Aquarius i Ntuition Viewer 4.4进行三维重建,确定测量层面,运用软件所带测量工具对手术节段、上位相邻节段和下位相邻节段双侧椎间孔孔径的相关指标进行测量,包括椎间孔上对角线、下对角线、高度和面积,对术前和术后手术节段、上位相邻节段及下位相邻节段双侧椎间孔的上对角线、下对角线、高度和面积进行统计学分析。结果:术前、术后同一节段双侧椎间孔的测量数据无显著性差异(P0.05),合并统计。术前手术节段、上位相邻节段及下位相邻节段椎间孔的上对角线和下对角线分别为5.55±0.81mm、5.64±1.00mm、5.48±0.95mm和6.11±0.99mm、5.91±1.02mm、6.07±1.02mm,术后分别5.49±0.92mm、5.73±0.94mm、5.45±0.81mm和6.04±1.06mm、6.06±0.96mm、6.01±1.01mm,术前、术后比较无显著性差异(P0.05)。术前手术节段、上位相邻节段及下位相邻节段的椎间孔高度和面积分别为8.70±1.08mm、9.60±0.98mm、9.20±1.0mm和0.35±0.08cm~2、0.41±0.12cm~2、0.36±0.09cm~2;术后手术节段、上位相邻节段及下位相邻节段的椎间孔高度和面积分别是9.35±1.02mm、9.02±1.15mm、8.62±1.08mm和0.38±0.08cm~2、0.39±0.12cm~2、0.34±0.09cm~2。术后手术节段椎间孔高度和面积较术前均显著性增大(P0.05),上位相邻节段和下位相邻节段椎间孔的高度和面积较术前显著性减小(P0.05)。结论:颈椎前路减压椎间融合器置入可以增大手术节段椎间孔的高度和面积,减小上位相邻节段和下位相邻节段的椎间孔高度和面积。     

颈椎椎体间撑开对椎间孔面积影响的实验研究

目的：确定颈椎椎间植骨块撑开高度与椎间孔面积的关系。方法：采用新鲜成人颈椎标本,以椎间盘高度为基础行椎间不同程度对称性撑开。Ｘ线４５°斜位摄片,图像分析计算椎间孔面积。结果：当撑开２～３ｍｍ时,椎间孔面积显著性增大（Ｐ＜０．０５）。结论：颈椎椎间植骨块撑开的理想高度为高出椎间盘２～３ｍｍ。     

不同椎间植骨高度对颈椎稳定性影响的实验研究

目的:观察下颈椎前路单椎间隙减压后不同高度植骨对颈椎即刻运动稳定性的影响,为临床上选择适宜的植骨高度提供依据。方法:采用6例新鲜成人尸体颈椎标本,取三面皮质骨髂脊植骨块,对完整状态、C5/6节段椎间隙减压术后应用不同高度骨块(基准高度的100%、120%、140%、160%)行椎间植骨5种状态下进行生物力学测试。在生物材料测试机上加载前屈后伸、左右侧屈、左右轴向旋转的三维运动;计算机图像处理软件测量C5/6节段在各状态下的三维运动范围;进行各状态间的多重比较分析。结果:6例标本C5/6椎间隙植骨的基准高度平均为6.86mm。所有骨块植骨成功,但160%基准高度植骨时骨块置入较困难,且1例标本出现了椎间隙前方残余软组织的撕裂。1例标本在基准高度植骨状态测定屈伸过程中出现了植骨块移位,但在测试过程中均无植骨块脱出。统计分析表明,140%和160%基准高度植骨时较基准高度植骨时C5/6节段前屈后伸、左右侧屈活动度明显减小(P<0.05),但两者间无显著性差异(P>0.05);160%基准高度植骨时C5/6节段的左右侧屈活动度较完整状态及120%基准高度植骨时明显减少(P<0.05);其余各状态间两两比较均无显著性差异(P>0.05)。结论:下颈椎单椎间隙减压后,撑开植骨可增加手术节段的即刻运动稳定性,理想的植骨高度为140%基准高度。     

颈椎前路经椎间隙减压Syncage椎体间融合

目的观察颈椎前路经椎间隙减压Syncage椎体间融合的稳定性及融合效果.方法采用颈前路经椎间隙减压Syncage椎体间融合术治疗颈椎病及颈椎间盘突出症17例,术后定期摄颈椎X线片检查,观察手术椎节的稳定性和融合情况.结果随访6～12个月,术后次日即下床活动,手术节段稳定,术后3～4个月融合,椎间高度恢复满意.结论Syncage颈椎椎体间固定融合技术使施术椎节立即稳定,重建椎间高度,适用于颈椎前路经椎间隙减压后椎体间融合.     

颈椎前路椎间撑开的实验研究

目的：研究撑开器撑开高度与撑开力的关系，探讨用撑开扭力的变化值来判断颈椎前路手术合适椎间撑开高度方法的可行性。方法：新鲜尸体颈椎标本6具，用带扭力显示的撑开器测定椎间撑开高度与撑开扭力变化，对结果进行统计分析和比较。结果：撑开扭力随撑开器撑开先平稳增加然后显著增加，依次切断不同结构后，撑开扭力值降低但变化相似，黄韧带切断后则不再表现扭力显著增加。结论：颈椎前路手术彻底减压后，撑开扭力显著增加为黄韧带紧张产生的阻力所致，根据扭力显著变化来确定合适的撑开高度的方法是可行的。     

棘突撑开与小关节、椎间孔形态变化关系的初步实验研究

目的 观察棘突撑开程度与小关节移位、椎间孔形态变化的关系.方法 使用6具新鲜腰椎尸体,制作标本,保留关节突周围关节囊韧带及棘间韧带,通过分别撑开L3/4,L4/5棘突,测量相应节段小关节间相对位移、椎间孔高度及宽度改变.结果 棘突撑开2 mm、4 mm后,L3/4、L4/5腰椎间孔高度增大、小关节位移改善均有明显差异,椎间孔宽度的改变在撑开2 mm无明显差异,在撑开4 mm时宽度增大有统计学差异.结论 棘突撑开能有效改善小关节位移、增加椎间孔高度,但对于椎间孔宽度的增加需要撑开足够距离.     

一体成型式皮质骨生物型颈椎椎间融合器在颈前路融合术中的应用

目的 探讨一体成型式皮质骨生物型颈椎椎间融合器应用于颈前路融合术的临床疗效.方法 2005年8月至2007年1月对15例颈椎病患者行前路减压一体成型式皮质骨生物型颈椎椎间融合器置入钢板内固定术,男12例,女3例;年龄45～68岁,平均54.6岁;颈椎创伤4例,退变性11例,病变节段C3-4 2例,C4-5 6例,C5-6 7例C6-7 3例;1个节段11例,2个节段4例.颈椎不稳5例,神经根型6例,脊髓型4例.术后对比手术前后椎间隙高度、颈椎前凸Cobb角,判断术后颈椎间融合情况.结果 15例患者术后获15～24个月(平均18.4个月)随访,术后即刻及末次随访时椎间隙高度和颈椎前凸Cobb角与术前相比明显改善,差异均有统计学意义(P<0.05);术后椎间隙高度和颈椎前凸cobb角与末次随访时比较,差异无统计学意义(P>0.05);日本骨科协会(JOA)评分:末次随访时与术前比较差异有统计学意义(P<0.05).随访期间15例患者X线片均示椎间融合,融合时间为3～6个月,平均4.2个月.结论 一体成型式皮质骨牛物颈椎椎间融合器可辅助维持脊椎的生理弧度和椎间隙的高度,提供颈椎初始及中期的稳定性,以实现椎问骨性融合及便于判断椎间融合情况.     

三种方法恢复颈椎生理曲度及椎间高度的比较

目的　分析颈前路减压术中不同撑开技术对恢复颈椎生理曲度及椎间高度的影响。方法　 1995 .7— 2 0 0 1.3月间施术的颈椎病患者 5 4例 ,按照术中椎间隙牵开方法的不同分为徒手牵开组、Cage牵开组及牵开器牵开组等三种。分别测量各组术前、术后颈椎生理曲度及椎节高度值 ,测量结果进行统计学比较。结果　牵开器牵开法及Cage牵开法较徒手牵开法颈椎生理曲度及椎节高度增加值大 ,且具显著性差异 (P <0 .0 1)。结论　术中牵开技术可影响颈椎生理曲度及椎节高度的恢复 ,牵开器牵开法对改善颈椎生理曲度及椎节高度较为理想。     

脊髓型颈椎病颈椎曲度与矢状面参数间相关性分析

背景:脊髓型颈椎病会导致颈椎矢状位参数的改变,造成严重的临床症状。由于颈椎的灵活性,仅通过某一颈椎矢状面参数测量的结果不一定具有说服力。目的:探讨脊髓型颈椎病患者的C2-C7 Cobb角与颈椎矢状面参数的相关性以及责任椎间隙高度、椎间成角与颈椎曲度的相关性。方法:收集75例脊髓型颈椎病患者的临床资料进行回顾性病例对照研究,男38例,女37例,年龄60~67岁,平均(64.2±2.1)岁。根据C2-C7 Cobb角测量数据分为两组。评价影像学结果,Jackson应力切线法测量的颈椎生理曲度、颈部倾斜、T1斜度、胸廓入口角、C2-C7矢状面垂直轴、C7斜度、责任椎间隙的活动度、高度和角度。结果:在颈椎矢状面参数中,除胸廓入口角与C2-C7 Cobb角无相关性,其他参数和C2-C7 Cobb角之间均有一定的相关性,其中T1斜度与C2-C7 Cobb角的相关性最强。C4/5、C5/6、C6/7节段的椎间隙高度和椎间成角与C2-C7 Cobb角显著相关。但在C3/4节段,只有椎间成角随C2-C7 Cobb角的增大而增大。结论:颈椎矢状面各参数是衡量颈椎间盘退行性改变的重要参考数据,颈椎椎间高度和椎间成角均影响颈椎曲度的变化。对于脊髓型颈椎病患者,在评估颈椎正常弯曲度时,除胸廓入口角,其他颈椎矢状面参数与C2-C7 Cobb角相当;但椎间成角比椎间高度更有意义。     

Cervical intervertebral disc space narrowing and size of intervertebral foramina

Computer-assisted simulation of C4-C5, C5-C6, and C6-C7 intervertebral disc space narrowing was performed on 16 anatomic specimen cervical spines to determine the relationship of the cross sectional foraminal areas with the degree of narrowing of the cervical intervertebral disc space. Compared with normal foraminal area values, reduction of 20% to 30% of the foraminal area was found after 1 mm narrowing of the intervertebral disc spaces; reduction of 30% to 40% of the foraminal area was found after 2 mm narrowing of the intervertebral disc space; and reduction of 35% to 45% of the foraminal area was found after 3 mm narrowing of the intervertebral disc space. Statistically significant differences were found among the remaining cross sectional foraminal areas after different degrees of intervertebral disc space narrowing. Compression of the nerve root within the intervertebral foramina after the collapse of the intervertebral disc space cannot be ignored, and an appropriate surgical procedure to maintain the normal height of the disc space is essential. The size of the intervertebral foramen is related directly to the height of the intervertebral disc space. A 3-mm vertical reduction of the intervertebral disc space is associated more frequently with severe narrowing of the neuroforamen.     

颈前路椎间撑开的在体研究

目的:研究颈椎前路手术中撑开的扭力变化,分析撑开扭力的构成原因,为椎间撑开有关问题提供量化依据。方法:用特制的能测定撑开扭力的颈椎前路撑开器,在41例三组病人颈椎前路次全椎体切除术中测定3种状态下撑开椎体时的扭力变化,统计分析其变化趋势,并分析其临床意义。结果:撑开扭力随着撑开的高度先平稳增加,前柱完全撑开时扭力急剧增加。不同病例组撑开的扭力增幅绝对值不等,但曲线类型相似,颈椎外伤病人最大撑开扭力较颈椎退变病人明显低(P<0.01)。结论:撑开扭力增幅曲线先缓慢增加后急剧增加,术中应逐步撑开,颈椎骨折时撑开力应相应减小,撑开扭力增幅明显增加的高度为合适椎间撑开高度。     

椎间隙高度在颈前路融合术中的研究进展

颈前路融合术是国内外脊柱外科工作者在手术治疗颈椎疾病的首选方式,其治疗颈椎退行性疾病、创伤及肿瘤等各种颈椎疾病的效果显著。颈椎前路融合术中需要使用撑开器对患椎间隙进行适当撑开,以充分暴露、解除致压因素,恢复病变节段的生理高度、曲度及稳定性,达到最佳的手术效果,但目前对于颈椎前路手术中患椎间隙的标准撑开高度尚无共识。本文将从椎间隙高度与颈椎间盘退变机制关系、术中椎间隙高度选择及椎间隙高度与术后效果等3个维度对椎间隙高度在颈前路融合术中的研究进展进行综述,以期为脊柱外科医师在术中行椎间撑开时提供理论依据及参考。     

Quantitative changes in the cervical neural foramen resulting from axial traction: in vivo imaging study

BACKGROUND CONTEXT: Cervical traction has a long history as a method of conservative treatment for cervical spine diseases. However, information on quantitative changes in the cervical neural foramen resulting from axial traction in vivo is lacking. PURPOSE: To quantitatively evaluate the changes in the neural foramen of the cervical spine during axial traction in vivo. STUDY DESIGN: A prospective radiographic analysis of the cervical neural foramen of adult volunteers. PATIENT SAMPLE: Fifteen healthy volunteers (10 men, 5 women) without any history of cervical spine disease. OUTCOME MEASURES: The changes in cervical cross-sectional foraminal areas and heights were measured. METHODS: Cervical magnetic resonance (MR) images of the volunteers were taken at the neutral position and were reconstructed in the oblique plane perpendicular to the long axis of each neural foramen from the C2-3 to the C6-7 level. The changes in the neural foraminal dimensions at incremental axial traction forces (0, 5, 10, and 15 kg) were analyzed. RESULTS: After each 5-kg incremental increase in traction weight, there was a significant (p value less than .05) increase in area and height of the intervertebral foramen compared with the position in which no weight was applied. There was an average increase of 5.81%, 16.56%, and 18.9% in the foraminal area and an average increase of 3.75%, 8.67%, and 10.43% in foraminal height compared with the position with no weight at traction of 5, 10, and 15 kg, respectively. There was no statistically significant difference for the increase in foraminal area and height from 10 to 15 kg of traction (p value greater than .05). CONCLUSIONS: There was a significant increase in intervertebral foraminal area and height after each 5-kg increment in traction weight compared with the position in which no weight was applied. From 10 to 15 kg of traction, there was no significant change in the foraminal area and height.     

不同颈椎间盘手术对邻近下位椎间孔影响的生物力学研究

目的探讨C5、6人工椎间盘置换、椎间盘摘除、前路椎间融合内固定后对邻近下位椎间孔形态改变的影响,为临床应用颈人工椎间盘置换提供理论依据。方法新鲜成人尸体颈椎标本11具,标本节段包括C3～T1椎体及其椎间盘。11具标本按测试先后顺序分成C5、6完整组、髓核摘除组、置换组及椎间融合内固定组,在0.75、1.50 Nm载荷下测量前屈和后伸状态邻近下位椎间孔高度、宽度的改变,并比较加载前后组内及组间的变化范围（range of variety,ROV）。结果各组颈椎标本在0.75 Nm和1.50 Nm前屈下,C6、7的椎间孔高度、宽度明显增加,在后伸下显著下降,且差异均有统计学意义（P〈0.01）。各组在0.75、1.50 Nm两级载荷下,组内比较位移变化明显,差异有统计学意义（P〈0.01）。在两种负载下,完整组、髓核摘除组与置换组在前屈和后伸状态下,组间两两比较邻近下位椎间孔高度和宽度ROV差异无统计学意义（P〉0.05）;融合组明显高于其余3组,且差异有统计学意义（P〈0.05）。在两种载荷的同组和同状态下,高度和宽度ROV比较差异均有统计学意义（P〈0.01）。结论实验初步证明颈人工椎间盘置换符合颈椎正常的生物力学要求;颈椎间孔屈曲时增大,后伸时减小;椎间融合可能是引起颈椎退变和/或退变加速的原因之一,亦可能是神经根型颈椎病和椎孔外臂丛神经卡压的原因之一。     

颈椎椎间孔三维CT测量的实验研究

目的:对颈椎椎间孔三维CT测量的准确性进行评估。方法:成人尸体颈椎标本5个,在椎间孔走向垂直的方向切割椎间孔,范围为C2~C7。观察椎间孔的解剖形态并测量其面积。标本行螺旋CT检查,并将图像传送至三维CT图像处理工作站。在不同阈值下进行三维重建,计算出诸椎间孔面积,并将所得数据与标本同一椎间孔的实体测量结果比较。结果:颈椎椎间孔在300Hu阈值下的测量值与标本测量值之间无显著性差异(P>0.05)。结论:三维CT对椎间孔的形态大小可作出正确的评估。     

经Delta通道椎间孔镜治疗神经根型颈椎病

目的:探讨经Delta通道椎间孔镜治疗神经根型颈椎病的早期临床疗效及安全性。方法:对2017年9月至2018年7月收治的10例神经根型颈椎病患者行经Delta通道后路椎间孔镜下椎间盘摘除术,其中男6例,女4例;年龄30～62(41.5±4.3)岁;均为单侧根性症状,其中C_(4,5) 2例,C_(5,6) 5例,C_(6,7) 3例。所有患者CT及MRI检查提示无后纵韧带骨化及黄韧带钙化等影像学表现,颈椎动力位X线片无颈椎不稳,经系统非手术治疗6周以上,疗效欠佳。观察患者术前及末次随访时颈肩痛VAS评分、JOA评分、NDI评分、颈椎生理曲度、颈椎病变节段椎间高度和稳定性的改变。结果:所有手术顺利完成,无脊髓、神经根或大血管损伤情况的发生。手术时间70～120 min,平均90 min;术中出血量30～90 ml,平均40 ml。10例患者均获得随访,时间6～14个月,平均9个月。所有患者术后神经根性疼痛缓解满意,神经功能有所改善。VAS评分由术前的7.15±2.01降至末次随访时的1.59±0.83;JOA评分由术前的12.57±1.24升至末次随访时的16.42±0.58;NDI评分由术前的41.82±4.71提高到末次随访时的9.59±3.52;末次随访与术前比较差异均有统计学意义(P0.05)。颈椎生理曲度D值由术前的(8.21±0.84) mm升至末次随访时的(10.89±0.96) mm (P0.05)。病变节段椎间高度术前、末次随访时分别为(5.62±0.59)、(5.60±0.57) mm,差异无统计学意义(P0.05)。末次随访时颈椎动力位X线片未见颈椎失稳。结论:经Delta通道后路椎间孔镜下椎间盘摘除术治疗神经根型颈椎病能取得较为满意的疗效,且不影响颈椎的稳定性,安全性可靠,值得临床应用。     

The quantitative measurements of the intervertebral angulation and translation during cervical flexion and extension

The insufficient exploration of intervertebral translation during flexion and extension prevents the further understanding of the cervical biomechanics and treating the cervical related dysfunction. The objective of this study was to quantitatively measure the continuous intervertebral translation of healthy cervical spine during flexion and extension by videofluoroscopic technique. A total of 1,120 image sequences were analyzed for 56 healthy adult subjects by a precise image protocol during cervical flexion and extension. our results showed there were no statistical angular differences among five spinal levels in either flexion or extension, except for the comparison between C2/3 (13.5°) and C4/5 (22.6°) angles. During cervical flexion, the smallest anterior translations were 0.7 mm at C2/3 level, followed by 0.9 mm at C6/7, 1.0 mm at C3/4, 1.1 mm at C5/6, and the largest 1.2 mm at C4/5 levels. The significantly greater translations were measured in the posterior direction at C3/4 (1.1 mm, P = 0.037), C4/5 (1.3 mm, P = 0.039), and C5/6 (1.2 mm, P = 0.005) levels than in the anterior one. The relatively fluctuant and small average posterior translation fashion at C6/7 level (0.4 mm) possibly originated from the variations in the direction of translation during cervical extension among subjects. Normalization with respect to the widths of individual vertebrae showed the total translation percentages relative to the adjacent vertebrae were 9.5, 13.7, 16.6, 15.0, and 8.6% for C2/3 to C6/7 levels, respectively, and appeared to be within the clinical-accepted ranges of translation in cervical spine. The intervertebral translations of cervical spine during flexion and extension movements were first described in quality and quantity based on the validated radiographic protocol. This analysis of the continuous intervertebral translations may be further employed to diagnose translation abnormalities like hypomobility or hypermobility and to monitor the treatment effect on cervical spines.     

A simplified technique for anterior cervical discectomy and fusion using a screw-plate implanted over the Caspar distractor pins

The author presents a simplified technique for midline screw-plate fixation in fusion procedures after anterior cervical discectomy, in which the plate is introduced over the Caspar distractor pins. The Uniplate system used, with a single screw in each vertebral body, minimizes bone damage to the vertebral body as the screws can be fixed in the holes previously used for the Caspar distractor pins. This simplified version of the classical anterior cervical fusion technique saves surgical time, facilitates screw insertion, and obviates the need for manipulations to stabilize the plate before the screws are inserted. It provides immediate stability comparable to other plate systems. To the author's knowledge, this is the first report on cervical fusion with the Uniplate system with the plate being introduced over the Caspar distractor pins.