前路手术选择性治疗无骨折脱位的颈脊髓中央损伤综合征

目的探讨颈椎前路手术治疗无骨折脱位的颈脊髓中央损伤综合征的适应证和效果。方法回顾性分析自2004年1月以来我科收治的无骨折脱位的颈脊髓中央损伤综合征的病例资料,筛选其中21例接受前路减压植骨融合手术治疗的病例,根据影像学特点分为有1~3个节段的退变性颈椎管狭窄组17例和有4~5个节段的发育性颈椎管狭窄组4例,二组均施行颈椎前路椎间减压、植骨融合、内固定手术,前者行1~3个节段手术;后者施行2~4个节段手术。手术前后均采用ASIA评分系统评定神经功能。记录手术方式、融合节段、术前及术后神经功能、融合情况,判断颈椎前路手术治疗无骨折脱位的颈脊髓中央损伤综合征的适应证和效果。结果退变性颈椎管狭窄或者椎间盘突出的病例,接受前路减压植骨融合手术后ASIA评分有明显升高;发育性颈椎管狭窄的病例,接受严重受压的2~4个节段前路减压植骨融合手术后ASIA评分有一定恢复。结论对于非发育性颈椎管狭窄的颈脊髓中央损伤综合征患者,根据脊髓受压和局限性椎管狭窄的节段,实施1~3个节段的前路减压植骨融合手术可以起到减压并为神经功能恢复创造有利条件的目的 ;对于长节段发育性椎管狭窄病例,实施后路椎管成形术或者一期前后路联合手术是更好的选择。     

Proximal symphalangism with "coarse" facial appearance, mixed hearing loss, and chronic renal failure: new malformation syndrome?

A 25-year-old man is described with short stature, moderate mental retardation, an abnormal facial appearance, a webbed neck, skeletal abnormalities including proximal symphalangism of bilateral second through fifth fingers, mixed hearing loss, and slowly progressive, sclerosing nephropathy. He was large at birth with generalized edema, more pronounced around the jaw, neck and the upper part of the body, but became short with increasing age, and currently measures 143 cm (-4.9 SD). He had intermittent proteinuria and slowly progressive deterioration of the renal function. A biopsy of the left kidney showed global glomerular sclerosis with interstitial fibrosis. He was placed on maintenance peritoneal dialysis at age 17 years, and now on hemodialysis. His skeletal abnormalities included, in addition to proximal symphalangism, stenosis of the cervical canal, scoliosis, brachydactyly of the hands, hypoplastic hip joints, and pes valgus. Other abnormalities noted were a communicating defects of the diaphragm (surgically corrected), bilateral inguinal hernia and cryptorchidism. These clinical manifestations indicate a hitherto undescribed combination of manifestations and nephropathy.     

Proximal symphalangism with “coarse” facial appearance,mixed hearing loss,and chronic renal failure: New malformation syndrome?

A 25‐year‐old man is described with short stature, moderate mental retardation, an abnormal facial appearance, a webbed neck, skeletal abnormalities including proximal symphalangism of bilateral second through fifth fingers, mixed hearing loss, and slowly progressive, sclerosing nephropathy. He was large at birth with generalized edema, more pronounced around the jaw, neck and the upper part of the body, but became short with increasing age, and currently measures 143 cm (−4.9 SD). He had intermittent proteinuria and slowly progressive deterioration of the renal function. A biopsy of the left kidney showed global glomerular sclerosis with interstitial fibrosis. He was placed on maintenance peritoneal dialysis at age 17 years, and now on hemodialysis. His skeletal abnormalities included, in addition to proximal symphalangism, stenosis of the cervical canal, scoliosis, brachydactyly of the hands, hypoplastic hip joints, and pes valgus. Other abnormalities noted were a communicating defects of the diaphragm (surgically corrected), bilateral inguinal hernia and cryptorchidism. These clinical manifestations indicate a hitherto undescribed combination of manifestations and nephropathy. © 2001 Wiley‐Liss, Inc.     

Central cord syndrome in a high school wrestler: a case report

Objective: To alert athletic trainers to the importance of recognizing the signs and symptoms of central cord syndrome. Background: A 15-year-old high school wrestler was found lying supine on the mat after sustaining a hyperextension injury to his neck while drilling during practice, complaining of numbness, tingling, and a burning sensation in all 4 extremities. Touching the extremities elicited an extreme burning sensation. After in-line stabilization of the cervical spine was performed, palpation of the spinous processes elicited tenderness and an increase in pain. Six weeks before the injury, the athlete had experienced forced lateral flexion of the cervical spine during a match, resulting in an episode of bilateral numbness and burning in his arms. On evaluation by the athletic trainer, symptoms were limited to the right hand, and brachial plexus neurapraxia was diagnosed. Differential Diagnosis: Central cord syndrome, brachial plexus injury, cervical spine injury, burning hands syndrome, Brown-Séquard syndrome, anterior cord syndrome. Treatment: Upon assessment, the athlete's cervical spine was immobilized until emergency medical services arrived and applied a cervical collar. Radiographs taken at the hospital revealed a congenital fusion of C6-7. Magnetic resonance imaging and computed tomography showed evidence of stenosis, a herniated disc at C3-4, and a central cord injury. He was admitted to the hospital for observation and was placed on a corticosteroid protocol. At approximately 1 week after the injury, the athlete underwent a cervical decompression and fusion at C3-4. Subsequently, he underwent extensive rehabilitation and has had some persistent neck stiffness. The athlete is no longer allowed to participate in contact sports as a result of the presence of stenosis at multiple levels. Uniqueness: Central cord syndrome is typically seen in an older population with cervical spondylosis and rarely occurs in young adolescents. However, this athlete sustained 2 central cord injuries, 1 mild and 1 severe, in less than 6 weeks' time. Conclusions: The original injury sustained by the wrestler was thought to be a brachial plexus injury but, in fact, was a mild central cord injury. Central cord syndrome was not suspected in the original injury because the athlete's complaint was of unilateral numbness. With the second injury, the central cord injury was more severe. Proper recognition, assessment, and handling of this situation were crucial in providing optimal care to this athlete.     

腰椎椎管狭窄症的中医药治疗研究

腰椎管狭窄症是指腰椎管内一个或多个平面管腔狭窄,神经压迫、移位引发的一种临床综合征,其病因主要为腰椎管退行性病变导致狭窄,或骨性/纤维性增生引发管腔狭窄,对患者生活质量影响较大。腰椎椎管狭窄症是中老年人常见的腰椎疾病,在我国发病率呈明显上升趋势,且呈年轻化态势。近年来,腰椎椎管狭窄症的中医药治疗方法不断优化改进,形成了多样化的治疗体系,治疗效果较为理想,成为治疗该病的重要途径。为进一步总结该病中医药诊治的研究成果,本文对腰椎椎管狭窄症的中医药诊治进展进行综述。     

经峡部入路治疗腰椎管狭窄症

目的总结经峡部入路治疗腰椎管狭窄症的临床应用结果。方法 2005年1月～2008年12月,对122例腰椎管狭窄症患者采用改良显微减压术治疗。其中,男88例,女34例。年龄49～78岁﹙平均56岁﹚。结果本组术后无神经损伤并发症,无伤口感染。手术时间50～90分钟﹙平均70分钟﹚,术中出血量90～200m﹙l平均150ml﹚。术后随访22～52个月﹙平均30个月﹚。术后恢复率按Macnab腰椎管狭窄疗效评定标准对疗效进行评定评,优良率为94%,未发生与手术相关的并发症。结论对腰椎管狭窄症的手术治疗重点应放在压迫引起症状的部位,而对无症状的部位不做预防性减压操作。经峡部入路术式老年人更容易耐受,减轻了对腰椎后部结构的损伤,更容易进入椎管,有利于进行神经根减压。     

急性脊髓损伤患者血清中单核趋化蛋白-1的表达及其意义

目的 :观察急性不完全脊髓损伤患者血清中单核细胞趋化蛋白 1(MCP 1)的表达 ,探讨继发性脊髓损伤的可能机制。方法 :收集 2 8例急性不完全脊髓损伤患者、8例单纯脊柱压缩骨折患者及正常对照的血清 ,ELISA方法检测其中MCP 1的水平 ,并分析其入院时的MRI资料。结果 :与健康对照相比 ,急性不完全脊髓损伤患者血清中MCP 1的浓度明显增高 (P <0 0 1) ;且水平与脊髓受压程度及脊髓损伤的病理类型有相关性 (P <0 0 5 )。结论 :MCP 1可能参与脊髓损伤部位的继发性炎症反应 ,其血清浓度与诊断、预后有一定关系。     

Cervical Klippel-Feil syndrome predisposing an elderly African man to central cord myelopathy following minor trauma

An otherwise-healthy, active 83-year-old Nigerian man developed reversible central cord myelopathy from a mild fall on a level surface. Cervical spine magnetic resonance imaging (MRI) revealed C5, 6, and 7 block vertebrae and marked disc extrusions only at the immediately adjoining upper and lower non-fused segments of the cervical spine. There was no spinal canal stenosis otherwise. We think that the unique presentation of this case of Klippel-Feil syndrome further supports the impression that following fusion (congenital or acquired) of one segment of the spinal column, hypermobility of the non-fused adjoining segments may strongly predispose to more disc extrusions.     

腹腔镜辅助下腰椎骨折前路减压内固定术

目的探讨在腹腔镜辅助下，经腹膜后腰肌间隙人路的小切口对腰椎爆裂性骨折椎管减压、植骨、内固定手术的可行性。方法13例腰椎爆裂性骨折，在腹腔镜辅助下经腹膜后腰肌间隙入路，应用腹腔镜、自制手术器械，进行椎体爆裂性骨折并脊髓圆锥、马尾神经压迫症病例的椎管减压、植骨、内固定手术。结果全部病例切口Ⅰ期愈合，椎管内骨块清除彻底。椎管减压充分，植骨块融合良好，内固定器无松动；1例L4椎体爆裂性骨折、马尾神经受压病例同时还伴有T6骨折、完全性截瘫，术后脊髓功能未恢复；4例圆锥、马尾神经受压，术后功能基本恢复。结论腹腔镜辅助下经腹膜后腰肌间隙人路的小切口腰椎手术，可以完成椎体爆裂性骨折并脊髓圆锥、马尾神经压迫症的椎管减压、植骨、内固定术。     

慢性颈脊髓压迫模型大鼠构建及评价

背景：在脊髓型颈椎病脊髓损伤发生机制的研究过程中,建立稳定且同人类体内疾病演变过程相似的疾病模型对于研究脊髓型颈椎病发病机制至关重要。 目的：构建慢性颈脊髓压迫模型,观察该模型病理生理变化特点,进一步明确脊髓型颈椎病受压脊髓组织的病理改变。 方法：30只SD大鼠随机均分为对照组、轻度压迫组、重度压迫组。将不同大小吸水性压迫材料聚乙烯醇丙烯酰胺互穿网络水凝胶植入C5-C7椎板下,制作慢性颈脊髓压迫动物模型,对照组不植入压迫材料。 结果与结论：MRI检查显示两压迫组大鼠出现不同程度的椎管狭窄和脊髓压迫,而对照组椎管宽度正常无脊髓压迫。电生理检测显示两压迫组大鼠运动诱发电位潜伏期较对照组明显延长且振幅明显降低(P < 0.05)。神经元免疫荧光染色显示对照组大鼠脊髓有大量形态规则的神经元,而两压迫组大鼠神经元计数明显减少且神经元胞体形态明显皱缩,脱髓鞘现象明显,3组间比较差异有显著性意义(P < 0.05)。压迫组大鼠脊髓压迫节段发现较多凋亡细胞,而对照组未发现。说明构建的大鼠慢性颈脊髓压迫模型符合脊髓型颈椎病的病理改变,且手术操作简便,不易感染死亡率低;神经元损伤、脱髓鞘改变和凋亡机制参与了大鼠慢性颈脊髓压迫损伤的发生发展过程。     

Expanded clinical spectrum of spondylocarpotarsal synostosis syndrome and possible manifestation in a heterozygous father

We report on a 5-year-old boy with spondylocarpotarsal synostosis (SCT) syndrome who presents with disproportionate short stature, thoracic scoliosis, pes planus, dental enamel hypoplasia, unilateral conductive hearing loss and mild facial dysmorphisms. Radiographs showed abnormal segmentation of the spine with block vertebrae and carpal synostosis. In addition to the typical phenotype of SCT syndrome, he showed pronounced delay of carpal bone age and bilateral epiphyseal dysplasia of the proximal femora. The patient's father has mild short stature and unilateral hip dysplasia. Molecular studies of the filamin B gene (FLNB) revealed a homozygous mutation in the index patient while both parents were heterozygous for the mutation. In this report we expand the phenotype of SCT syndrome in a patient with a causal FLNB mutation.     

纳米人工椎板在脊柱椎板缺损修复中的临床应用

目的探讨纳米羟基磷灰石/聚酰胺66﹙n-HA/PA66﹚人工椎板在脊柱切除全椎板的临床应用,防止硬脊膜粘连受压,修补椎板缺损,后路融合稳定脊柱,形成椎管的作用.方法30例脊柱疾病患者外科手术中均应用人工椎板﹙n-HA∕PA66﹚治疗,修复于肿瘤、椎管狭窄、椎体滑脱,脊柱骨折,颈椎病伴发育性椎管狭窄、后纵韧带骨化等切除全椎板患者术中所致成的椎板缺损.结果30例术后切口均I期愈合,随访6~18个月,患者症状不同程度改善.X 线片及 CT 片示人工椎板与骨接触面界限消失,融合良好.结论纳米人工推板修复缺损的椎板,融合完成椎管成形,稳定了脊柱后柱,防止脊膜暴露后的并发症,并具有人体椎板的生物力学性能和广泛的实用性.     

无骨折脱位型颈髓损伤解剖机制与治疗方式选择的探讨

目的探讨成人无骨折脱位型颈髓损伤解剖机制与治疗方式选择。方法通过回顾性病例对照研究,对我们医院2000～2009年43例无骨折脱位型颈脊髓损伤患者的临床资料进行分析。资料分为两组:A组为非手术组,共15例;B组为手术治疗组,共28例。A组又分为A1组:颈椎管内无压迫、椎管矢状径正常者,6例;A2组:颈椎管内存在致压,矢状径15mm者,9例。B组分为B1组:颈椎管内无压迫、椎管矢状径≥15mm者,共7例;B2组:颈椎管内存在致压,矢状径小于正常范围者,共21例。比较、A1与B1组、B1与B2组、A2与B2组之间在治疗前后JOA评分。结果各组在治疗后感觉及运动功能均较治疗前有明显提高(P0.05);B组(手术组)疗效明显优于A组(非手术组)(P0.05)。但A1与B1组、B1与B2组疗效的差异无统计学意义(P0.05);B2组的疗效明显优于A2组(P0.05);A1组的疗效明显优于A2组(P0.05)。结论对无骨折脱位型颈脊髓损伤,应根据受伤机制及影像学检查,有针对性地选择治疗方式,可以获得较好的临床结果。     

Osteological features in pure-bred dogs predisposing to cervical spinal cord compression

Relative to body size, midsagittal and interpedicular diameters of the cranial and caudal aspects of cervical vertebral foramina (C3–C7) were found to be significantly ( P < 0·05) larger in small breeds than in large breeds and Dachshunds, and also larger in Dachshunds ( P < 0·05) than in large breeds. This condition increases the risk for spinal cord compression resulting from relative stenosis of the cervical vertebral foramina, especially in large dogs, and this is also exacerbated by the typical shape of the vertebral foramina (i.e. dorsoventrally flattened cranially and bilaterally narrowed caudally). Within large dogs those breeds highly predisposed to cervical spinal cord compression were Great Danes (the breed with the smallest midsagittal vertebral foramen diameters from cranial C6 to cranial T1) and Doberman Pinschers, because of the most strikingly cranially dorsoventrally narrowed cone-shaped vertebral foramina at C6 and C7. The existence of a small midsagittal diameter in the cranial cervical spine was a high risk factor predisposing to spinal cord compression in small breeds and Dachshunds. Remarkable consistency was noted between the spinal level of the maximum enlargement of the spinal cord which previously was reported to be at C6, and the site of maximum enlargement of the vertebral canal currently stated in Dachshunds and small breeds. In large breeds the maximum enlargement of the vertebral canal tended to be located more caudally at the caudal limit of C7. The average age at which large dogs were most susceptible to noxious factors causing abnormal growth of the pedicles was determined to be 16 wk.     

脊柱脊髓手术围术期镇痛管理进展

继血压、脉搏、呼吸和体温之后,疼痛被确认为"第五生命体征"。脊柱脊髓手术的术后疼痛属神经病理性疼痛的范畴。剧烈疼痛可影响患者全身多个系统。因此,脊柱脊髓手术的术后镇痛极为重要。     

Nontumor lesions of spinal cord and spine

Nontumor lesions of the spinal cord and spine include developmental disorders, cystic tumor-like lesions, vascular disorders, infective diseases, demyelinating diseases, degenerative diseases, metabolic and toxic disorders, and spinal cord injury. In addition, diseases of the spine and extradural spaces secondarily cause spinal cord injury. Aside from tumors, these include developmental abnormalities, inflammatory diseases, nontumor space-occupying lesions, and tumor-like lesions such as lipomas, vascular malformations, and cysts. Awareness is required of hemostatic agents used during surgery and subsequently presenting as space-occupying lesions, which have to be differentiated from recurrent lesions. On the therapeutic front, stem cell transplantation into spinal cord for treatment of neurodegenerative disorders, spinal cord injury, and multiple sclerosis is a challenging prospect.     

Mesoaxial complete syndactyly and synostosis with hypoplastic thumbs: an unusual combination or homozygous expression of syndactyly type I?

Syndactyly type I is an autosomal dominant condition with complete or partial webbing between the third and fourth fingers or the second and third toes or both. We report here a previously undescribed phenotype of severe mesoaxial syndactyly and synostosis in patients born to affected parents. The characteristic features of these severe cases are (1) complete syndactyly and synostosis of the third and fourth fingers; (2) severe bone reduction in the proximal phalanges of the same fingers; (3) hypoplasia of the thumbs and halluces; (4) aplasia/hypoplasia of the middle phalanges of the second and fifth fingers; and (5) complete or partial soft tissue syndactyly of the toes. We report on three offspring with this phenotype from two different branches of a syndactyly type I family, suggesting that they may be homozygous for this condition. SSCP and linkage analysis indicated that neither HOXD13 nor other relevant genes in the chromosome 2q31 region was responsible for this phenotype.     

过量氟化物致腰椎黄韧带的退变与骨化

背景：黄韧带是脊柱后部的重要连接结构,一旦出现退变导致其弹性下降,在各种影响因素作用下,可使椎管的有效空间更加减小,导致脊髓、神经根受压,出现神经症状,严重者可致瘫痪、病残。目的：分析过量氟化物导致大鼠腰椎黄韧带退变与骨化的作用机制。方法：选取雄性SD大鼠30只,随机分为两组,观察组饮用含NaF(质量分数为10^-4)蒸馏水,对照组给予等量的蒸馏水,分别于3,6个月后检测骨密度,血清、骨组织标本中Ca²⁺、P³⁺含量和血清碱性磷酸酶活性;且行大鼠腰段黄韧带标本X射线检查后组织病理观察。结果与结论：观察组3个月后有5只大鼠下门牙开始出现白垩色条纹或斑点,6个月后大鼠均出现氟斑牙,表现为广泛的白垩色,且大鼠中腰椎骨密度显著增加(P < 0.05);观察组大鼠在3个月和6个月时其血清Ca²⁺均显著高于对照组,P³⁺显著低于对照组,差异均有显著性意义(P < 0.05);且血清碱性磷酸酶的活性在3个月和6个月时均显著高于对照组(P < 0.05);6个月后X射线检查发现大鼠腰椎骨质密度明显增高;病理观察结果显示观察组大鼠黄韧带中弹力纤维数量进一步减少,胶原纤维大量增生,大量的成纤维细胞与钙盐沉积,且在椎板附着处可见韧带骨化形成。结果提示过量氟化物可造成SD大鼠腰椎黄韧带的退变、骨化,可能在黄韧带的骨化中可能起重要作用。中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Compromise of the spinal canal in Proteus syndrome

We report on 2 children with spinal stenosis and neurologic sequelae. They illustrate the 2 ways in which spinal compromise may develop in Proteus syndrome—vertebral anomalies or tumor infiltration. In one patient, spinal stenosis resulted from an angular kyphoscoliosis. In the other, cord compression resulted from infiltration of a paraspinal, intra-thoracic angiolipoma. © 1993 Wiley-Liss, Inc.     

Embryonic intermediate filament,nestin, expression following traumatic spinal cord injury in adult rats

Precursor cells in the ependyma of the lateral ventricles of adult mammalian brain have been reported in brain, and also in the spinal cord. The present study used antibody to the intermediate filament protein (nestin) as an immunohistochemical marker for neural stem cells and precursor cells in a rat model of spinal cord trauma. Male Sprague-Dawley rats (n=25) had a laminectomy at Thll-Thl2, and spinal cord contusion was created by compression with 30 g of force for 10 min. The rats were killed at 24 h, 1 week and 4 weeks after injury, and four levels of the spinal cord were examined: 5 mm and 10 mm, both rostral and caudal region to the injury center. Time- and region-dependent alterations of nestin immunoreactivity were analyzed. Revealed at 24 h post-injury, 5 mm rostral and caudal to the lesions, nestin expression was observed in ependymal cells and around the hemorrhagic and necrotic lesion located in dorsal spinal cord, peaking at 1 week after injury. Moreover, nestin expression was also observed in the white matter of ventral spinal cord, extending into arborizing processes centripetally from the pial surface toward the central canal. At 4 weeks after injury, nestin expression in ependyma decreased 10 mm from the injury site. But nestin expression in white matter increased dramatically with a 100-fold increase in nestin originating from the pial surface, and extension now to all the white matter. The latter was accompanied by glial fibrillary acidic protein positivity into very long arborizing processes, morphologically compatible with radial glia. The findings suggest two possible sources of precursor cells in adult mammalian spinal cord; ependyma of the central canal and subpial astrocytes. Subpial astrocytes may be associated with neural repair and regeneration after spinal cord injury.