腰椎椎间管和椎间管外区应用解剖学研究

目的：探讨不同节段腰椎椎间管和椎间管外区同有性结构特点。方法：作者对32具肿国成人 腰椎骶椎骨标本进行了形态研究。结果：L1－L5椎弓根水平宽、椎板峡部宽、下关节突最外侧缘至正中矢状面距离和L1至S1上关节突最外侧经级至正中矢状面距离逐渐增大,尤以L4、L5增大显著;L4、L5横突基部下缘较其它3个椎骨横突基部下缘显著下移,因而L4／L5、L5／S1关节突关节显著上移。结论：从后面观,L1／L2至L5／S1手术窗逐渐减小并显著向外侧移,尤以L4／L5、L5／S1显著。     

单枚融合器行经椎间孔腰椎椎体间融合的解剖学观测

背景:有部分学者认为,与经椎间孔腰椎椎体间融合技术相关的手术器械是按照西方人体格设计,和国人体格存在一定的差异,甚至融合物难以置入,所以探讨相关的解剖技术就显得很有必要.目的:测量腰椎椎间孔及与经椎间孔腰椎椎体间融合相关的解剖参数.方法:对14具正常成人尸体脊柱腰段椎间孔宽度、长度、高度进行了观测;对腰椎各结构与后正中矢状面的距离进行了观测.结果与结论: 结果表明腰段(L1～L5)椎间孔宽度逐渐变小;L1-L4椎间孔高度逐渐增大,L5略小于L4,L1～L5高度均明显大于其宽度(P＜0.01);L1～L5椎间孔长度逐渐增大(P＜0.05).L1至L5椎板峡部宽、下关节突最外侧缘至后正中矢状面距离逐渐增大,其性别间、左右间差异均无显著性意义(P＞0.05).结果表明国人经椎间孔入路能满足高度9～14 mm单枚椎间融合器斜向置入,单枚椎间融合器置入不会因牵拉硬膜囊和神经根而导致脊髓与神经根损伤.     

超声引导下经椎间孔硬膜外注射的可行性

目的观察猪标本超声引导下腰椎经椎间孔硬膜外注射的可行性及准确性。方法取来自2只巴马小型猪的L1-6节段脊柱及椎旁部分组织,分别在双侧L1-2、L2-3、L3-4、L4-5、L5-6椎间孔完成超声引导下经椎间孔硬膜外穿刺,应用腰椎X线片和CT检测穿刺针位置;大体观察穿刺针入路和针尖位置,记录穿刺针皮肤入针点与后正中线距离、入针深度和入针角度,并进行左右对比。结果穿刺成功率95%(19/20),其中穿刺针针尖位于椎间孔下缘、腹侧、中央区和旁中央区的占80%(16/20)。成功穿刺时,左右侧穿刺针皮肤入针点与后正中线距离、入针深度、入针角度无显著性差异(|t|<1.475,P>0.05)。结论超声引导下经椎间孔硬膜外穿刺有较高准确率。     

正常腰椎椎间小关节角度的CT测量研究

目的　为了研究正常人群腰椎间关节与矢、冠状面角度。方法　采用CT扫描 ,测量 10 0例正常人腰椎小关节与冠状面的角度 ,每 10岁为一年龄组 ,男女性别各区分 5组。结果　①相同腰椎节段不同年龄组之间椎间小关节与冠状面所成角度差异无显著性 (P >0 .0 5 ) ;②相同腰椎节段椎间小关节与冠状面所成角度 ,男女两性之间差别无显著性 (P >0 .0 5 ) ;③椎间小关节与冠状面的角度大小与腰椎的节段呈负相关 ,从L1,2 至L5S1水平 ,椎间小关节与冠状面角度有逐渐减小或与矢状面的角度有逐渐增大的趋势 ;④L1,2 ～L3 ,4椎间小关节与冠状面所成的角度为 62 .1°～ 5 3 .1° ,L4,5～L5S1为 44 .5～ 3 7.7°。结论　CT是观察腰椎小关节结构较准确的方法。L1,2 ～L3 ,4椎间小关节角度偏矢状面 ,L4,5～L5S1椎间小关节角度更偏冠状面。     

脊柱颈段的三维断层解剖及临床意义

目的为脊柱颈段的影像诊断和手术治疗提供解剖学资料。方法在横断、矢状和冠状断面上分别观测寰枢关节、椎间孔等结构及其毗邻关系，用游标卡尺测量横突孔等重要结构的径线。结果脊柱颈段横断面清晰显示寰枢正中关节、寰椎横韧带、椎间孔及脊神经根等，寰椎前后径7．18mm，横径7．42mm；矢状断面较好显示齿突尖韧带、椎动脉等，横突孔矢状径6．32mm(男)、6．14mm(女)；冠状断面清晰显示寰枢外侧关节、脊神经根及钩椎关节等重要结构。结论脊柱颈段的三维断层解剖对颈段病变的影像诊断和手术治疗具有重要的临床意义。     

椎间高度指数在青年准间盘突出症患者中的影响分析

将青年椎间盘突出症（LDH）患者43例及同龄正常健康人20例进行侧位X线片摄影,测量各节段椎间间隙,比较青年LDH患者与健康成人椎间间隙的差异、青年LDH患者男女各节段椎间间隙对比情况。结果青年LDH患者与健康人群在各节段椎间间隙平均值对比无统计学差异,P〉0.05,在L5/S1对比有统计学意义,t=3.059,P〈0.01;青年LDH患者在L3/L4节段椎间间隙男性显著高于女性,t=3.059,P〈0.01,其它节段未见统计学意义。青年LDH患者的L5/S1节段椎间间隙可以作为诊断椎间盘突出的依据之一。     

中国人Wiltse椎旁肌间隙入路的观察与测量

背景：应用Wiltse椎旁肌间隙入路可减少手术对椎旁肌的损伤,但目前对于最长肌与多裂肌间隙解剖位置的确定仍无精确的标准。目的：通过对国人尸体解剖和腰椎MRI影像的观察测量,熟悉椎旁肌间隙入路的局部结构特点,确定腰椎不同节段椎旁肌间隙的具体位置,为此入路的临床应用提供经验和参考。方法：采用10具经防腐处理的成人尸体标本进行解剖观察,寻找并钝性分离双侧最长肌与多裂肌间隙,测量L2和L4棘突水平最长肌与多裂肌间隙距后正中线距离。采用400例患者腰椎MRI的影像资料进行观察,测量L2/L3-L5/S1各椎间盘水平双侧最长肌与多裂肌间隙至后正中线距离,分析其与性别、年龄的关系。结果与结论：10具尸体最长肌与多裂肌间隙表面均未见重要血管、神经分布,间隙底部可见上关节突及横突根部,L2棘突水平最长肌与多裂肌间隙距后正中线距离为（2.3±0.3）cm,L4棘突水平最长肌与多裂肌间隙距后正中线距离为（3.4±0.6）cm。400例患者腰椎MRI影像资料中,L2/L3-L5/S1椎间盘水平最长肌与多裂肌间隙至后正中线距离依次为（19.71±1.93）mm、（23.49±2.49）mm、（27.49±2.84）mm和（31.36±3.15）mm,与患者性别、年龄无显著相关性。实验为Wiltse椎旁肌间隙入路的临床应用提供了有价值的参考,建议在进行椎旁肌间隙入路手术之前常规进行MRI测量,减少医源性损伤。     

腰椎间孔扩大成形在椎间孔镜技术中的意义

目的 评价腰椎间孔扩大成形在椎间孔镜技术（PELD）中的意义,探讨腰椎间孔扩大成形对术中神经根显露的影响及两者的相关性.方法 2015年6月到2016年2月应用椎间孔镜技术治疗单纯性L4～5椎间盘突出症66例,男30例,女36例;年龄31～68岁,平均43.6岁.根据术后上关节突正中矢状面CT结果,将椎间孔成形分成Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型,依据脊柱内镜下神经根显露情况,将镜下神经根分成A型、B型、C型、D型、E型;分析椎间孔成形分型与镜下神经根分型的关系.结果 不同椎间孔扩大成形与神经根显露程度差异有统计学意义（P〈0.05）.结论 腰椎间孔扩大成形在椎间孔镜技术中具有重要作用,随着椎间孔成形加大,神经根显露会更加充分.     

前路经寰枢关节螺钉内固定钉道解剖学测量及临床意义术

背景:前路经寰枢关节螺钉内固定术在国外是治疗寰枢椎不稳定的一种新方法,国人相关解剖学数据文献报道极少.目的:测晕前路经寰枢关节内固定术钉道的相关解削学数据.设计、时间及地点:测量性实验,于2006.09/2008.04在南方医科大学解剖教研室和解放军广州军区武汉总医院骨科完成.材料:中国成人配套寰枢椎十燥标奉50套,不分性别、年龄,外观排除畸形和破损,采用国产电子游标卡尺(精度0.01 mm)及普通国产量角器(精度为0.5°)进行测量.方法:以枢椎前弓下缘与枢椎椎体侧缘交界点上方4 mm处即枢椎上关节面下骨凹陷处为进钉点,分别向寰椎侧块后外上角中部拧入1枚长度适当的螺钉,螺钉尖不得穿透寰椎上关节面.主要观察指标:①钉道最,小外偏角、最大外偏角、最小后倾角、最大后倾角.②内侧钉道距离、外侧钉道距离.③进钉点至枢椎正中的距离、枢椎体正中与枢椎横突孔内侧缘的距离、进钉点与枢椎横突孔内侧缘的距离.结果:50套寰枢椎干燥标本均进入结果分析.在矢状面上螺钉置入的最小外偏角左侧为(10.80±2.10)°,右侧为(10.76±2.40)°;最大外偏角左侧为(25.13±3.12)°,右侧为(25.12±2.86)°;冠状面上最小后倾角左侧为(8.85±2.12)°右侧为(9.28±2.65)°;最大后倾角左侧为(26.96±3.09)°, 右侧为(27.49±2.51)°;内、外侧钉道左侧长度分别为(17.48±2.10)mm和(25.41±2.59)mm,右侧为(17.4g±2.23)mm和(25.58±2.42)mm;枢椎正中至进钉点距离左侧为(9.8±0.69)mm,右侧为(9.81±0.66)mm;枢椎正中至枢椎横突孔内侧缘距离左侧为(14.12±1.28)mm,右侧为(14.60±1.38)mm;进钉点与枢椎横突孔内侧缘的距离左侧为(6.28±1.38)mm,右侧为(6.79±1.39)mm..结论:前路经寰枢关节螺钉置入中,两侧置入螺钉的理想钉道角度为外偏10°～25°,后倾9°～27°,理想的螺钉长度为17～25mm,由枢椎前缘正中向外分离显露不宜超过14 mm.     

脊柱后路内窥镜治疗极外侧椎间盘突出症6例分析

极外侧型腰椎问盘突出症是指突出物位于侧隐窝外侧,椎间孔及椎间孔外的腰椎间盘突出。国外报道其发生率为10.3%~11.7%,而国内报道的发生率明显偏低,约为1.2%[1]。治疗极外侧型腰椎间盘突出症的传统手术方式为经后侧腰椎板间隙入路,椎间孔扩大和关节突切除完成。我科在后路治疗极外侧型腰椎间盘突出症术式的基础上,采用内窥镜技术行椎间盘髓核摘除,神经根减压松解术6例,取得了良好的效果,总结如下。1临床资料1.1一般资料本组男5例,女1例,年龄35~63(平均53.2)岁,病程1.5~3.5(平均2.5)个月。L4/5突出2例,L5/S1突出4例;左侧突出4例,右侧突出2例;M R I检查4例,示硬膜囊无明显受压。1.2手术方法术前行X线摄片定位,局麻,蛙式卧位。在患者病变椎间隙平面,棘突中线旁开2.0~2.5 cm处,以上横突下缘和椎板外缘交汇处为进针点经骶棘肌插入导针,固定工作通道,连接显示及摄像系统.由浅入深逐渐分离软组织,双极电凝止血,逐步显露棘突间韧带,咬除部分上位横突下缘,剥离横突间韧带在上位横突下缘的附丽点,咬除横突问韧带;显露椎管侧壁,见椎问盘多位于两神经根之间,尤以1条神经根压迫为甚,出现水肿,牵...     

磁共振成像技术应用于颞下颌关节紊乱病的评价

目的:通过各种MRI扫描序列比较,选择颞下颌关节紊乱病(temporomandibulardisorder,TMD)的最佳检查方法。方法:对13例患者,采用PHILIPS公司的GyroscanIntera型超导磁共振成像系统,磁场强度1.5T,选择11cm双侧表面线圈,9例采用双侧对比成像,4例单侧成像,共22侧。扫描闭口矢状位的自旋回波(SE)T1WI,快速自旋回波(FSE)T2WI,质子密度(PDW)及各种快速梯度回波(FastFieldEcho,FFE)T1W和T2W序列;冠状位扫描T1W和张口矢状位T1W。结果:各种扫描序列均可以显示颞下颌关节(TMJ)的基本解剖结构,从对比度、空间分辨率、信噪比和扫描时间几方面评价,FFE序列在缩短扫描时间的同时保持了一定的信噪比,优于常规SE序列,3D/FFE序列分辨率高,对关节盘、软骨显示好,并能在任意方向多平面重建,可进行精确的体积测量。结论:FFE序列优于常规SE序列,3D/FFE序列更适合于TMJ的检查。     

Cervical zygapophyseal joints: geometrical parameters and relationship to cervical kinematics

The relationship was examined between the height and slope of the cervical zygapophyseal joints and the patterns of motion of the cervical vertebrae. The height and orientation of the C₃---C₇ superior articular processes were measured in lateral radiographs of 40 normal subjects. The C₄-C₆ facets were oriented at approximately 40° to the vertical, while the C₃ and C₇ facets were more steeply oriented. The heights of the superior articular processes were found to increase at progressively lower vertebral levels. Contrary to published views, the slope of the superior articular facets has no bearing on the pattern of motion of the cervical vertebrae. No relationship was found between slope of the facets and the location of the instantaneous axes of rotation of the cervical vertebrae. In contrast the height of the articular processes was perfectly related to the location of the axes of rotation. Articular height, but not slope, is a major determinant of the patterns of motions of the cervical vertebrae.

This study provides data necessary to confirm or deny the putative roles of the cervical zygapophyseal joints in determining motion of the cervical spine in the sagittal plane.     

Belt effects on lumbar sagittal angles

OBJECTIVE: The study examined the belt effects on the change of lumbar sagittal angles. DESIGN: The effects of pelvic and lumbar belts on lumbar sagittal angles were examined both radiographically and videographically in standing, erect sitting, and slump sitting. BACKGROUND: The resulting changes of lumbar angles when wearing belts with different mechanical characteristics should be different. METHODS: Eighteen healthy male subjects participated in this study. L1/L3, L3/L5, L5/S1 and L1/S1 were measured with the aid of lateral radiographs. The external joint angles were also measured via the motion analysis system. RESULTS: Radiographic data revealed an interactive effect between working posture and the use of a belt (P<0.046) on the change of L1/S1. In standing, both belts increased L1/S1 by increasing almost all the lumbar vertebral angles. In erect sitting, wearing lumbar belt had no effect but the pelvic belt decreased L1/S1 mainly through a decrease in L1/L3. In sitting slump with trunk flexion of 15 degrees, both belts increased L1/S1 and restricting the movement of the pelvis. CONCLUSIONS: Belt effect to the change of lumbar sagittal angles in posture which involve knee flexing and/or trunk flexing seems not as the same as in standing posture. RELEVANCE: This study related internal vertebral angles and externally measured trunk angles with lumbar and pelvic belt usage.     

前方前牵引疗法治疗替牙期骨性Ⅲ类错牙合患儿的头颅影像及外貌变化

目的 探讨前方前牵引疗法治疗替牙期骨性Ⅲ类错牙合患儿的疗效。方法 选取口腔正畸科治疗的替牙期骨性Ⅲ类错牙合患儿80例,根据患儿家属要求分成观察组和对照组,每组40例。其中观察组行前方前牵引治疗,对照组在观察期间未进行治疗。观察组在治疗前后、对照组观察前后拍摄X射线头颅侧位片,测量上下颌骨水平及矢状向生长该变量的相关指标：上齿槽座（SNA）角、下齿槽座（SNB）角、ANB角（SAN角与SNA角之差）、面角（FH‐NP）、AH点到腭平面的垂直距离（FH‐PP）、上中切牙长轴与鼻根点至上齿槽座点连线的交角（U1／NA）、上中切牙切缘到鼻根点至上齿槽座点连线的距离（U1‐NA）、下中切牙的长轴与NB连线的交角（L1／NB）、下中切牙的长轴与NB连线的距离（L1‐NB）。结果 与对照组相比,观察组患儿的SNA角增大1．37°（ P＜0．05）,SNB角减少1．80°,ANB角增大到3．39°（ P ＜ 0．05）,FH‐NP、FH‐PP值变小（ P ＜0．05）,U1／NA 增大2．13 mm ,U1‐NA增加3．03 mm（ P ＜0．05）,L1／NB减少3．89°,L1‐NB减少0．86 mm（ P ＜0．05）。观察组下颌骨平均旋转量为0．82,而对照组下颌骨的平均旋转量为－0．66。结论 对观察组替牙期骨性Ⅲ类错牙合患儿行前方前牵引治疗后,患者的下颌骨发生顺时针旋转,上下颌关系更加协调,面部容貌较之前有很大改观。     

Sagittal plane moment arms of the female lumbar region rectus abdominis in an upright neutral torso posture

BACKGROUND: Prior imaging studies of torso muscle moment arms for use as inputs into biomechanical models have been derived from subjects lying supine. Recent research suggests moment arms of the rectus abdominis are larger when standing versus lying supine. METHODS: Axial MRI images, through and parallel to the intervertebral discs were obtained from five females in a standing upright neutral posture. Digitizing software was utilized to quantify the distance in the sagittal plane between the centroids of the intervertebral disc and the rectus abdominis muscle, and converted to the transverse plane to allow comparisons with studies with subjects in a supine posture. FINDINGS: The mean sagittal plane moment arms in the transverse plane were 9.7, 9.1, 8.5, 8.5 and 9.8 cm at the L(1)/L(2), L(2)/L(3), L(3)/L(4), L(4)/L(5) and L(5)/S(1) intervertebral levels, respectively. Compared with a study on females of a similar age group, the moment arms from this study were larger at each level, increasing from 7.3% larger at L(1)/L(2) to 43.7% larger at L(5)/S(1). INTERPRETATION: Accurate anatomical geometrical representation in biomechanical models is necessary for valid estimates of internal loading. Sagittal plane rectus abdominis moment arms were larger from the upright neutral torso posture in this study compared to studies with subjects lying supine. This suggests the torso internal moment generating capability would be represented differently in biomechanical models that use data from studies where subjects were upright, which is more reflective of the postures biomechanical models are utilized for, than when using anatomical geometry derived from supine postures.     

Precision measurement of segmental motion from flexion-extension radiographs of the lumbar spine

OBJECTIVE: To measure sagittal plane motion of lumbar vertebrae from lateral radiographic views. Previously identified factors of imprecision such as distortion in central projection, off-centre position, axial rotation, and lateral tilt of the spine were compensated. STUDY DESIGN: This study presents a new protocol to measure sagittal plane rotational and translational motion from lateral flexion-extension radiographs of the lumbar spine. BACKGROUND: Conventional methods to determine sagittal plane rotation and translation are prone to error from the distortional effects of the divergence of the radiographic beam and the measurement error inherent in constructing tangents to the contours of the vertebral body. High precision is attained by roentgen-stereophotogrammetric methods, but because of their invasive nature they can be applied only in exceptional cases. Agreement has been reached only in that measurement of sagittal plane motion from lumbar spine flexion-extension radiographs is inaccurate. Normal patterns of sagittal plane motion and the definition of what is an abnormal flexion-extension radiograph have not been settled. METHOD: Starting from an analysis of vertebral contours in the lateral view, geometric measures are identified which are virtually independent of distortion, axial rotation or lateral tilt. Applying a new protocol based on those geometric measures, the pattern of translational and rotational motion was determined from flexion-extension radiographs of 61 symptom-free, adult subjects. Measurement errors were quantified in a specimen experiment; a reproducibility study quantified inter- and intraobserver errors. RESULTS: Magnitude and sign of 'translation per degree of rotation' determined from a cohort of 61 adult subjects were very uniform for all levels of the lumbar spine. An auxiliary study evaluating a cohort of 10 healthy subjects where flexion-extension radiographs had been taken standing and side-lying showed no dependence of the rotation/translation pattern on posture. The error study demonstrated errors in angle ranging between 0.7 and 1.6 degrees and errors in displacement ranging between 1.2% and 2.4% of vertebral depth (the largest errors occurring at the L(5)/S(1) segment). Intra- and interobserver tests showed no or only negligibly small bias and an SD virtually equal to the measurement error multiplied by radical2. The relation of displacement to angle observed in the normal cohort can be used in individual cases to predict translational motion depending on the rotation actually performed. A comparison of the predicted translation (determined from normal controls) and the value actually measured allows translational hypo-, normal, or hypermobility to be quantified. Examples illustrate application of the new method in cases of normal, hypo-, and hypermobility and in the case of an instrumented spine. CONCLUSIONS: The results of this study show that precision of the measurement of rotational and translational motion can be considerably enhanced by making allowance for radiographic distortional effects and by minimizing subjective influence in the measurement procedure.     

腰椎管狭窄症椎管狭窄的MRI测量及其临床意义

目的：分析引起腰椎管狭窄症患者椎管狭窄的形态特点,指导临床手术治疗。方法：我院门诊及住院120例患者,男62例,女58例,年龄45-76岁,平均57.2岁,分为4个年龄段（40-49岁29例、50-59岁42例、60-69岁33例、70-79岁16例）,所有患者常规行腰椎MRI检查。观察椎板、椎管、黄韧带、小关节的形态特点,测量L2/3、L3/4、L4/5、L5/S1轴位经椎间盘关节突平面黄韧带厚度、椎板厚度、椎管矢状径及椎管冠状径;分析各测量参数在不同年龄段、椎体节段的变化特点。结果：椎管狭窄类型：中央型椎管狭窄27例、侧隐窝型狭窄35例、混合型58例;小关节增生：单侧33例、双侧87例;椎管形态：＂三角形＂76例、＂三叶草形＂44例;黄韧带平均厚度在L2/3（2.4 mm）、L5/S1（3.1 mm）轻于L3/4（3.7 mm）、L4/5（4.5 mm）;随着年龄增加,黄韧带厚度增加,且L4/5增厚最明显;椎板厚度在L5节段最小4.5 mm,在L3节段最大,为5.8 mm,椎管冠状径在L4/5节段最小4.7 mm,在L2/3节段最大,为10.3 mm,二者随着年龄增加,在各个椎体节段变化不明显;黄韧带增厚,椎管冠状径变小。结论：1黄韧带增生肥厚引起椎管冠状径变小、双侧关节突关节尤其是上关节突增生内聚是椎管狭窄的主要因素;2手术时应扩大椎管的冠状径,切除黄韧带及部分关节突、扩大侧隐窝,保留棘突复合体。     

Analysis of in-vivo articular cartilage contact surface of the knee during a step-up motion

BackgroundNumerous studies have reported on the tibiofemoral articular cartilage contact kinematics, however, no data has been reported on the articular cartilage geometry at the contact area. This study investigated the in-vivo tibiofemoral articular cartilage contact biomechanics during a dynamic step-up motion.MethodsTen healthy subjects were imaged using a validated magnetic resonance and dual fluoroscopic imaging technique during a step-up motion. Three-dimensional bone and cartilage models were constructed from the magnetic resonance images. The cartilage contact along the motion path was analyzed, including cartilage contact location and the cartilage surface geometry at the contact area.FindingsThe cartilage contact excursions were similar in anteroposterior and mediolateral directions in the medial and lateral compartments of the tibia plateau (P > 0.05). Both medial and lateral compartments were under convex (femur) to convex (tibia) contact in the sagittal plane, and under convex (femur) to concave (tibia) contact in the coronal plane. The medial tibial articular contact radius was larger than the lateral side in the sagittal plane along the motion path (P < 0.001).InterpretationsThese data revealed that both the medial and lateral compartments of the knee experienced convex (femur) to convex (tibia) contact in sagittal plane (or anteroposterior direction) during the dynamic step-up motion. These data could provide new insight into the in-vivo cartilage contact biomechanics research, and may provide guidelines for development of anatomical total knee arthroplasties that are aimed to reproduce normal knee joint kinematics.     

The effect of sagittal alignment on adjacent joint mobility after lumbar instrumentation--a biomechanical study of lumbar vertebrae in a porcine model

BACKGROUND: The mechanisms and changes in range of motion of neighboring mobile segment (adjacent level) after the instrumented posterior stabilization are not completely understood. This study aims to investigate the effect of sagittal alignment on the adjacent joint mobility after lumbar instrumentation. METHODS: Eight fresh porcine lumbar spines were instrumented with pedicle screw implants from L2 to L4. Each specimen was tested in three different sagittal alignments. Group A were instrumented in lordotic alignment (lordosis 20 degrees ), Group B in straight alignment (lordosis 0 degrees ), and Group C in kyphotic alignment (kyphosis 20 degrees ). Hydraulic testing machine was used to generate an increasing moment in flexion and extension respectively for each specimen. The vertebral displacement of the disc between L1-L2 and L4-L5 were measured simultaneously with an extensometer. FINDINGS: There were no significant differences in vertebral displacement between the three different sagittal alignments in both the superior and inferior adjacent segments under extension motion. However, under flexion motion, the vertebral displacement on the superior adjacent segment (L1-L2) with kyphotic alignment was statistically larger than that of the straight and lordotic alignments (P = 0.0198 and P = 0.000473 respectively), and no differences were found between the three different sagittal alignments on the inferior adjacent segment (L4-L5). INTERPRETATION: The iatrogenically produced kyphotic lumbar spine by posterior instrumentation might cause larger adjacent joint mobility on the superior adjacent joint as compared to the instrumented lordotic lumbar spine. This study implies that an instrumented spine in lordosis is less likely to develop adjacent instability than a kyphotic spine.     

自体髂骨嵌入式植骨和桥接钢板置入固定治疗尺骨远端缺损性萎缩性骨不连21例

背景:坚强的固定和骨折部位充足的血供是治疗骨不连的基本保证.目的:观察自体髂骨植骨和桥接钢板置入固定治疗尺骨远端缺损性骨不连的疗效.设计、时间及地点:自身对照观察,于2002-08/2006-05在上海交通大学附属第六人民医院骨科完成.对象:入选尺骨远端缺损性骨不连21例,其中尺桡骨双骨折引起的骨不连13例,单纯尺骨骨折引起的骨不连8例.首次发病开放性骨折15例,闭合性骨折6例.骨缺损1.5～5.0 cm,平均3.1 cm.方法:应用嵌入式髂骨植骨,填充骨缺损处.同时控制尺骨的长度和轴线,用5～8孔1/3管形钢板、重建钢板或锁定钢板桥接固定,最远端至少固定2枚螺钉,近端3枚或4枚螺钉.固定后每个月随访1次,观察临床表现和X射线片.主要观察指标:骨折愈合情况,测量其腕关节背伸和掌屈活动度,前臂旋前和旋后活动度.结果:21例患者平均随访14.7个月.所有患者均获骨性愈合,愈合时间3～7个月,平均4.6个月.19例对位对线良好,1例冠状面成角<10°,另1例矢状面成角15°,优良率90.5%.结论:自体髂骨嵌入式植骨和钢板桥接固定治疗尺骨远端缺损性骨不连,能够重建尺骨长度,矫正畸形,取得良好的骨愈合和功能恢复.