L_5-S_1间成角增大与临床相关性研究

目的了解腰骶角、L5~S1间成角(LSA)与腰椎稳定的相关性。方法测量患者站立腰椎侧位X线片腰骶角及LSA,并做腰椎间盘CT检查,结合患者临床症状,通过统计数据处理分析其相关性。结果腰骶角对腰椎稳定性影响不大,而LSA与腰椎稳定性成正相关,并随年龄增长而增大。结论LSA增大综合征是腰椎不稳及腰椎间盘疾患的主要因素。     

儿童先天性下腰椎和腰骶段半椎体畸形冠状面平衡状况与外科矫形选择

目的分析不同矫形方式对儿童先天性下腰椎和腰骶段半椎体畸形冠状面平衡的影响及疗效。方法将20例先天性下腰椎和腰骶段半椎体畸形患儿纳入研究,按术前冠状面平衡状况分为A组(平衡)、B组(对侧偏离失衡)、C组(同侧偏离失衡)。均行一期后路半椎体切除联合椎弓根钉内固定植骨;A组行凸侧与凹侧压缩、撑开均等正畸;B组行单纯压缩;C组增加L_5/S_1反向凸侧撑开、凹侧压缩正畸。至少随访24个月,观察正畸情况。结果术后A组5例维持冠状面平衡,B组仅1例未纠正平衡,C组全部平衡;末次随访冠状面、矢状面Cobb角以及冠状面、矢状面平衡与术前比较均显著改善;末次随访盆骨倾斜角为(1.09±1.0)°,与术前差异显著(P0.05)。末次随访冠状面、矢状面Cobb角正畸率分别为(68.34±9.25)%、(45.63±7.75)%。三组均无明显并发症和不良反应。结论冠状面失衡在儿童先天性下腰椎和腰骶半椎体畸形中较常见,一期后路半椎体联合椎弓根钉植骨具有一定疗效,需在术中根据患者冠状面排列情况进行恰当的正畸操作。     

三维有限元在正常与后凸畸形胸腰椎体力学性能比较中的应用

目的:比较分析T12、L1脊柱椎体下表面在纵向压缩载荷下的应力分布及变化趋势,为胸腰段脊柱后凸畸形患者的治疗及康复提供生物力学依据。方法:通过新鲜脊柱标本CT扫描影像建立正常的T10-L2段脊柱三维计算机模型,再通过自由造型系统重建脊柱后凸畸形15°模型。对两种模型均施加纵向800N压缩载荷,比较分析T12、L1椎体下表面的应力分布及变化趋势。结果:正常T12、L1椎体在承受纵向压缩载荷时,主要载荷集中在椎体后部以及脊柱的后部结构;后凸畸形T12、L1脊柱主要靠椎体承受纵向压缩载荷,且载荷主要集中于椎体前部。结论:在纵向压缩载荷下,正常脊柱T12-L1段椎体后部容易损伤和骨折,后凸脊柱T12-L1段椎体前部容易损伤和骨折。     

1例应用可撑开型人工假体钛肋治疗胸廓发育不良综合征合并脊柱侧凸的护理

患者 男性，14岁。胸廓发育不良综合征合并脊柱侧凸矫形术后8年，于2001年4月13日首次入院，Cobb’s角95°，在全麻下行前路开胸脊柱融合（T5-11），脊柱后路融合术（T1-L1），术后恢复顺利，出院后给予石膏外固定6周，佩戴支具2年，     

经椎弓根内固定治疗退行性腰椎侧凸并椎管狭窄症：半年随访矫正角度无丢失

背景：研究认为单纯椎管减压治疗退行性腰椎侧凸并椎管狭窄难以获得长期疗效,因为单纯减压被视为一种医源性的腰椎失稳,从而加重腰椎畸形。 目的：分析腰后路减压、矫形固定、融合治疗退行性腰椎侧凸并椎管狭窄,半年随访矫正角度评价。 方法：退行性腰椎侧凸并椎管狭窄患者23例均采用腰后路减压、矫形固定、融合治疗。采用症状目测类比评估表、Oswestry功能障碍指数评分表、SF-36调查问卷、腰椎冠状位Cobb角对患者治疗前和末次随访时生活质量变化情况及矫正角度进行评价。 结果与结论：患者随访均超过6个月。Cobb 角治疗前平均（23.94±177;11.4）°;,治疗后平均（10.28±177;6.93）°;治疗后末次随访患者平均目测类比评分显著低于治疗前（P 〈0.05）;治疗后末次随访Oswestry功能障碍指数评分显著低于治疗前（P〈0.05）,Oswestry功能障碍指数评分改善优良率为83.33%;治疗后SF-36调查问卷中的8个维度分值均较治疗前明显提高（P〈0.05）。半年随访期间矫正角度无明显丢失,融合器无移位,内固定无断裂,植骨融合率100%。     

腰椎间盘吸收综合征的X线及CT诊断

目的讨论X线平片及CT诊断腰椎间盘吸收综合征（IDR）的临床价值。方法对20例患者行腰3／4、4／5及腰5／骶1椎间盘平面CT扫描，层厚3．75mm，对腰椎正侧位片及横断面CT图像进行综合分析。结果20例患者诊断为腰椎间盘吸收综合征，其中腰4／5椎间盘3例，腰5／骶1椎间盘17例，腰椎正侧位片均可见孤立性腰椎间隙狭窄、邻近椎体终板硬化、椎体骨质增生，CT表现为椎间盘膨出及突出6例，硬膜囊受压17例，侧隐窝及椎间孔狭窄14例，椎间盘真空现象17例，小关节硬化13例。结论腰椎间盘吸收综合征的诊断主要依靠影像学检查，X线及CT扫描可以显示此征全部细节，对临床诊断及治疗具有重要价值。     

双层探测器光谱CT钙抑制成像检出腰椎固定术后施莫尔结节1例

患者男,61岁,3个月前因外伤致L1、L2椎体压缩性骨折接受T12~L3椎体金属内固定术,术后感下腰痛。查体:背部正中见纵行术后瘢痕,L3、L4棘突及周围组织压痛(+)、叩击痛(+),脊柱活动受限,双下肢皮肤感觉未见明显异常。腰椎MRI:矢状位T2WI见T12~L3椎体内见金属内固定物伴短T2金属伪影,对应椎体及局部附件骨质显示不清,T12-L1见真空征,L2-S1 T2信号不同程度减低,L3-4上缘局部膨隆、显示欠清,L 3-5后缘膨出(图1A);诊断为腰椎内固定术后,腰椎退行性变,L3-5膨出。腰椎CT:矢状位传统CT去金属伪影(orthopaedic metal artifact reduction,O-MAR)重建图像示胸腰椎体内固定物金属伪影减少,周围及邻近椎体、附件仍见伪影;腰椎椎体骨质不同程度增生,L1椎体楔形变,L2椎体前缘骨质欠连续,L3-5高度降低,边缘硬化(图1B);双层探测器光谱CT矢状位O-MAR并钙抑制重建图像(钙抑制指数=60)示金属内固定物呈低密度,腰椎骨质轮廓清晰,椎间盘轮廓显示不清,L3椎体下缘见施莫尔结节(图1C);诊断为腰椎内固定术后退行性变,L3椎体施莫尔结节形成。     

老年慢性腰背痛患者腰骶角、腰椎重力线指数与病情指标之间的相关性分析

目的:分析老年慢性腰背痛患者病程、Oswestry指数(ODI)两病情指标与腰骶角、腰椎重力线指数两影像学指标之间的相关性,为老年慢性腰背痛诊治提供参考.方法:2008年10月至2009年5月收集102例门诊就诊的慢性腰背痛患者,记录患者病程,测量ODI,测量患者站立侧位X线片腰骶角、腰椎重力线指数,分析病程、ODI和腰骶角腰椎重力线指数之间的相关性.结果:该组患者中,病程与腰骶角之间的相关系数r=0.145(P=0.147),病程与腰椎重力线指数之间的相关系数r=0.287(P=0.003);ODI与腰骶角之间的相关系数r=0.113(P=0.259),ODI与腰椎重力线之间的相关系数r=0.245(P=0.013).结论:老年慢性腰背痛患者病情指标与腰椎重力线之间的相关系数大于其腰骶角之间的相关系数,且有统计学意义,改善腰椎重力线指数的锻炼方法能改善老年慢性腰背痛患者病情.     

正常人群胸腰段椎体楔变指数的MRI测量

背景：虽然MRI在脊柱创伤中广泛应用,但国内尚未建立正常人群胸腰段椎体的MRI形态学参数。目的：利用 MRI 观测健康人群胸腰段椎体的楔变指数,为胸腰段压缩骨折和正常人楔形变的鉴别诊断提供MRI形态学依据。方法：征集2011年11月至2013年8月20-50岁健康志愿者120名,利用1.5T磁共振成像仪对志愿者行胸腰段扫描。在快速自旋回波T2WI正中矢状位上测量T11-L2椎体前缘高径、后缘高径,并计算楔形变指数。结果与结论：T11-L2椎体楔形变指数分别为0.91±0.05,0.91±0.05,0.88±0.08,0.91±0.08。T11-L2椎体存在楔形变的椎体个数分别为103个（23.52%）,112个（25.57%）,115个（26.26%）,108个（24.66%）。各年龄组间楔形变指数值差异无显著性意义,但年龄较大者楔形变指数较小。男性志愿者楔形变指数值小于女性志愿者。重体力劳动者T11、L2楔变指数小于非重体力劳动者。楔形变指数与身高及体质量指数呈负相关。结果可见正常人群胸腰段椎体存在不同程度的楔形改变,并且楔变程度与多种因素有关。     

腰椎椎间盘先天性发育不良1例

患者,女,21岁。2月前出现腰痛,弯腰及久坐久站后疼痛加重,腰后仰及侧弯腰痛不加重。1周前腰痛加重特来我院。体检:腰椎无侧凸,腰椎生理曲度变直,L1-S1椎间隙、双侧棘旁无压痛,双侧骶棘肌无痉挛,腰椎活动范围:前屈65°,后伸30°,左右旋转30°,左右侧屈30°,双腿直腿抬高试验80°,直腿抬高加强试验(-),仰卧挺腹试验(-),骨盆分离及挤压试验(-)     

Epidemiology of Thoracolumbar Spine Injury in Blunt Trauma

OBJECTIVE: To evaluate the prevalence, distribution, and demographics of thoracolumbar (TL) spine injuries following blunt trauma. METHODS: Prospective, cross-sectional study of a consecutive sample of all blunt trauma patients presenting initially to the emergency department (ED) of a Level 1 trauma center and undergoing thoracic and/or lumbar spine radiography from August 1997 to November 1998. The age, sex, and mechanism of injury of each patient as well as location and type of spine injury were recorded for those patients with vertebral fractures, dislocations, or subluxations. RESULTS: Two thousand four hundred four blunt trauma patients were enrolled. Vertebral injuries were identified in 152 individuals (6.3%, 95% CI = 5.4% to 7.4%). Two hundred sixty distinct anatomic levels of injury were identified in these 152 individuals. Of these 260 injuries, 42 (16.2%) occurred at L1, 38 (14.6%) at L2, 29 (11.1%) at L3, and 27 (10.4%) at T12, making these the most commonly injured vertebrae. Injuries were most common (34 patients) in those aged 30-39 years and were least common (12 patients) in those under 18 years. Compression fractures (52%) were the most common injury in the thoracic spine, while transverse process fractures (48%) were the most common injuries in the lumbar spine. CONCLUSIONS: The prevalence of TL injuries in ED blunt trauma patients undergoing TL radiographs is 6.3%. The most commonly injured area of the TL spine is the thoracolumbar junction.     

Percutaneous intradiscal approach to the posterior annulus using a curved cannula and a flexible nucleotome – a technical note

Automated percutaneous lumbar diskectomy (APLD) is now a widely practiced treatment of herniated lumbar disks. To be effective, however, the herniated disk must still be contained by the annulus and posterior longitudinal ligament. Only 20% of herniated disks operated on are still contained. To increase the applicability of the percutaneous approach to lumbar disk disease, a more direct manipulation of the herniated disk is necessary. Our work with a tethered cannula demonstrates the feasibility of gaining access to a posterior annular rent with the posterolateral approach to the disk that avoids the epidural space and eliminates the major problem of epidural fibrosis. We have demonstrated that a flexible suction cutting device, the minimally traumatic flexible Nucleotome, can be placed through the curved cannula and directed through the annular rent into the region of the herniation. The design of the suction cutting device of the Nucleotome is such that it maximizes the safety of such a procedure. The blunt end of the instrument, as well as the recessed port, minimizes the chance of injuring the dura by tenting it, thereby keeping it away from the port. The modified Nucleotome console with a ‘suction only’ mode coupled with an awake patient should help minimize the chance of nerve root damage. In conclusion, the cadaver experiments demonstrate the physical feasibility of approaching the posterior annulus from inside the disk using a posterolateral approach.     

Dose Optimization in Lumbar Spine Radiographic Examination by Air Gap Method at CR and DR Systems: A Phantom Study

ObjectiveThis study aims at investigating the feasibility of replacing an antiscatter grid with an air gap to achieve dose reduction for lumbar spine radiography while retaining image quality at an acceptable diagnostic level.MethodsFrontal and lateral projections of lumbar spine radiographic examinations were performed on an anthropomorphic phantom. Nongrid images of both the computed radiography (CR) and digital radiography (DR) systems with air gap thickness ranging from 0 to 25 cm were produced and compared with their corresponding grid images. Dose measurements using thermoluminescent dosimeters at the ovary and testes regions of the phantom were conducted. The image quality of all the images was evaluated by five radiographers using image quality score and visual grading analysis tests. Data on dose measurements and image quality tests were input for statistical analysis. The dose area product (DAP) of all the examinations was recorded and input for the computation of effective doses using a PC-based Monte Carlo program (PCXMC 2.0; STUK, Helsinki, Finland).ResultsSignificant dose reduction effects on the ovaries of 60.2%–74.1% and 55.1%–73.3% were found, respectively, at the frontal and lateral projections of nongrid lumbar spine examinations compared with their corresponding grid ones in both the CR and DR systems. Results on the image quality score and visual grading analysis tests showed that nongrid images with 10-cm and 5-cm of air gap thicknesses respective to the frontal and lateral images of the lumbar spine were rated with the highest scores. In general, a dose reduction effect using the air gap method was found to be more pronounced in the CR system compared with the DR system. Nevertheless, the CR system delivered a 2.4–4.5 times higher ovary dose respective to the frontal and lateral projections of lumbar spine examinations compared with the DR system.ConclusionsTen and 5 centimeters were found to be the optimal air gap thicknesses respective to the frontal and lateral lumbar spine radiographic examinations of the tested Rando phantom (Alderson Laboratories, Stamford, CT) in both the CR and DR systems. Significant dose reduction effects on both the ovary and testes regions of the nongrid examinations were shown. The effective dose computed from PCMCX 2.0 reflected that the risk of cancer induction was halved when an antiscatter grid was replaced by the nongrid method with an optimal air gap thickness in the tested examinations. Further reduction on cancer risk could be achieved by using DR instead of the CR system.     

不稳定性腰椎骨折患者围术期的护理

目的探讨不稳定性腰椎骨折患者围术期护理。方法回顾性分析43例不稳定性腰椎骨折患者围术期护理的临床资料。结果本组43例不稳定性腰椎骨折患者通过积极的手术治疗及围术期护理,减轻了患者的痛苦,促进了功能的恢复。结论适当的围术期护理对提高不稳定性腰椎骨折患者的治疗效果及并发症的预防起着重要的作用。     

几种腰前屈活动度评定方法的比较

目的探讨准确、简易、价廉的腰前屈活动度的临床评测方法.方法对50例正常青年人分别用评分法、改良的Schober法、量角器法、距离测定法和电子测角器测定法进行腰屈曲活动度的评测,并将各种方法与电子测角器法进行比较.结果评分法、量角器法和距离法与电子测角器测定的腰和髋共同屈曲度高度相关(r=0.805,0.728,-0.906;P＜0.01);改良的Schober法与电子测角器测定的腰屈曲度低度正相关(r=0.372,P＜0.01).结论距离测定法和电子测角器测定法与腰前屈活动度相关性最好.     

CT在腰椎椎弓峡部不连中的临床应用

目的探讨CT在腰椎椎弓峡部不连诊断中的临床价值及提高检出率。方法用PICKER-1200CT机检查，总结56例不伴有明显椎体移位的腰椎椎弓峡部不连患者凹征象，并结合定位像进行分析。结果腰椎椎弓峡部不连的特征性表现是椎弓骨性环连续性中断。在CT诊断明确的腰椎椎弓峡部不连的病例中，37例在侧位定位像上，同一腰椎上、下小关节突问出现骨质不连续，19例局部骨质结构紊乱、增粗。结论常规CT检查腰椎间盘病变时，在不伴有明显椎体移位的情况下，如果定位像上腰椎椎弓部上、下小关节突间出现骨质不连续，类似椎体“断尾征”，以及局部骨质结构紊乱、增粗时增加扫描范围，对腰椎弓峡部不连的早期诊断有一定意义。     

Motor skill training in musculoskeletal pain: a case report in chronic low back pain

Purpose: Low back pain is a chronic condition that limits function. The chief reason individuals with low back pain seek care is difficulty performing functional activities. A novel approach to improving performance of painful and limited functional activities is motor skill training, defined as challenging practice of activities to learn or relearn a skill. The purpose of this report is to describe the design and application of a motor skill training intervention in a 26-year-old man with a 10-year history of low back pain.

Methods: A motor skill training intervention was implemented to modify the altered alignment and movement patterns he used during the performance of his painful and limited activities.

Results: The patient was seen for six visits in 12 weeks. The patient reported decreased pain and medication use, as well as improved function immediately, 3-, and 9-months post-intervention.

Conclusion: Individuals with low back pain report limitation in ability to perform everyday functions and demonstrate altered patterns of movement and alignment during these activities. This case report describes an innovative motor skill training intervention that directly addresses the performance of functional activities and the application of motor learning principles.

• Implications for rehabilitation

• Low back pain is a chronic condition that limits function.

• The chief reason individuals with chronic low back pain seek care is difficulty performing everyday functional activities.

• Motor skill training is a novel approach that directly addresses the performance of painful and limited functional activities through challenging practice to improve performance and decrease pain.

     

Effect of Changes in Weight-Bearing Exercise on Lumbar Bone Mass after Age Fifty

This two year longitudinal study of 40 healthy subjects over age fifty (27 exercisers, 13 non-exercisers) was designed to evaluate the impact of weight-bearing exercise on lumbar bone mineral density as assessed by quantitative computed tomography. In both males and females exercising at moderate levels, a high correlation was found between changes in exercise and changes in bone density (r = 0.78 and 0.91, respectively P < 0.002). For extreme levels of exercise (>300 min/week in females over age fifty, and >200 min/week in males over age seventy) bone density was low, confirming earlier cross-sectional results. Subjects without change in their exercise levels and non-exercisers lost similar amounts of bone. Increasing body mass index was identified as a protective factor with regard to lumbar bone loss. We conclude that in exercisers continuation of weight-bearing exercise is mandatory to prevent excessive bone loss. Extreme levels of exercise may be detrimental to bone density in subjects over age fifty years.     

脊柱肌力平衡术矫正儿童麻痹性腰椎侧凸：（附4例报告）

作者创用一种新的矫正儿童麻痹性腰椎侧凸的手术方法——脊柱肌力平衡术,手术分2期施行,第1期Axer手术加凹侧腹直肌止点移位到凸侧,半年后行第2期手术凸侧背阔肌止点移位至髂嵴,凹侧骶棘肌止点移位到凸侧髂后上棘。临床治疗4例,腰椎侧凸矫正,凸侧腹壁麻痹包消失,恢复了脊柱肌力双侧的平衡,无并发症,且避免了腰椎侧凸的发展。本法尤其适应于未发生器质性改变以前的麻痹性腰椎侧凸。