颈椎前路减压并发脊髓损伤的高危因素回顾分析

目的探讨颈椎前路减压加重脊髓损伤的危险因素.方法对颈椎前路减压并发脊髓损伤加重11例回顾分析.结果所有病例颈椎椎管、椎体矢径比值均＜0.7,椎管横断面狭窄率在C4～5、C5～6间隙＞40%.结论一旦脊髓损伤加重,早期后路扩大半椎板减压是一种可选择的治疗方法.     

无骨折脱位型颈脊髓损伤程度的影响因素研究

目的探讨无骨折脱位型颈脊髓损伤程度的影响因素。方法回顾性分析44例无骨折脱位的颈脊髓损伤病例的MRI资料。从矢状位和轴位图像观察记录：脊髓损伤的长度，脊髓损伤处椎间盘突出最大径，椎间盘突出类型，脊髓损伤处椎管前后径、黄韧带厚度、椎体后缘骨赘有无和脊髓损伤节段，同时记录患者的年龄和性别。以脊髓损伤长度为应变量，以性别、年龄、椎间盘突出最大径、椎管前后径、椎间盘突出类型、黄韧带厚度、椎体后缘骨赘有无、脊髓损伤节段为自变量，进行多因素相关性分析。结果①44例中，脊髓损伤的长度为3～22mm，椎间盘突出的最大径为4～8mm，椎管前后径为4～9mm，黄韧带厚度为2—7mm，脊髓损伤平面位于C。～C，水平。②颈脊髓损伤的程度与颈椎间盘突出程度、颈椎管径前后径、颈椎黄韧带的厚度、颈脊髓损伤节段相关，差异有显著性意义（P〈0、01）。结论无骨折脱位的颈脊髓损伤的程度与颈椎间盘突出程度正相关，与颈椎管径前后径负相关，与颈椎黄韧带的厚度、颈脊髓损伤节段相关，与椎间盘突出的类型、椎体后缘有无骨赘、性别和年龄无关。     

Anterior spinal cord syndrome after initiation of treatment with atenolol

Anterior spinal cord syndrome is a rare condition with a variety of precipitating factors. Patients typically complain of weakness or paralysis of the extremities, often accompanied by pain, but frequently without a history of trauma. A 48-year-old man presented to the emergency department complaining of neck pain and inability to move his legs in the absence of trauma. Several hours prior he had seen his private physician and was given a dose of atenolol for elevated blood pressure. He had not previously been on medications for hypertension. His neurological examination revealed bilateral paralysis of the lower extremities. In the upper extremities he had weakness and sensory loss at the level of C6. Rectal tone was decreased and without sensation. Cervical and thoracic spine magnetic resonance imaging showed spondylotic disc disease, with disc herniation at C6-7 causing severe spinal canal stenosis. Despite i.v. methylprednisolone, pressors, and a prolonged intensive care unit course, the patient was discharged 5 weeks later with continued neurological deficits. Anterior spinal cord syndrome results from compression of the anterior spinal artery and often occurs in the absence of traumatic injury. The recognition, management, and prognosis of this condition are discussed.     

下颈椎前路内固定联合后路经关节金属螺钉置入固定的生物力学稳定性

背景:对退变性颈椎管狭窄单纯采用前路椎体次全切除或椎间盘切除或单纯后路单开门椎管扩大成行均不能彻底完成脊髓减压和脊柱三柱稳定。目的:探讨下颈椎前路固定联合后路经关节螺钉固定的生物力学稳定性。方法:正常成人尸体颈椎标本,每具分别制作以下两种模型:①经后路C3～C7单开门和下颈椎前路C5椎体次全切除钛网支撑植骨、ORION内固定模型(对照组)。②经后路C3～C7单开门和经关节螺钉内固定及下颈椎前路C5椎体次全切除钛网内植骨、ORION内固定模型(实验组)。结果与结论:实验组在前屈、后伸、左、右侧屈及左、右旋转移位角度均小于对照组(P<0.001)。提示:①在生物力学实验中,下颈椎前路固定联合后路经关突节螺钉固定的生物力学性能优良,对抗前屈、后伸、左、右旋转的作用力更强,颈椎可获得更可靠的稳定性。②下颈椎前路固定联合后路经关节螺钉固定在对抗颈椎前屈运动时力学稳定性更为强大。     

长节段颈椎后纵韧带骨化症修复：后路椎板切除植骨内固定与前路椎体次全切除减压的比较

背景：后纵韧带骨化症前路手术是通过直接减压,取出压迫的骨赘、骨化的后纵韧带,前路间盘从而达到彻底减压,通过置入钢板、钛网,产生前路支撑作用,有利于恢复颈椎生理曲度。但对于范围超过3个节段的患者,实施前路无法彻底切除骨化物,且减压难以维持颈椎曲度和稳定性,实施后路手术更为合适。目的：对比分析后路椎板切除植骨内固定与前路椎体次全切除减压修复长节段颈椎后纵韧带骨化症的效果。方法：从秦皇岛市第三医院2011年9月至2013年9月收治的长节段颈椎后纵韧带骨化症患者中选择34例进行观察,分别给予前路椎体次全切除减压（对照组）和后路椎板切除植骨内固定（观察组）治疗。所有患者治疗前均常规进行颈椎X射线、CT及MR检查,治疗后7 d进行复查。检查椎管矢状径、颈椎曲度、椎管狭窄率、骨化物分型、骨化物范围（节段）脊髓压迫率。并对患者进行日本骨科学会（JOA）评分,并计算其神经功能改善情况。结果与结论：经影像学检查,两组患者的椎管矢状径和治疗前颈椎曲度等指标比较差异均无显著性意义（P均〉0.05）,但治疗后两组颈椎曲度和脊髓压迫率差异均有显著性意义（P均〈0.05）,观察组优于对照组。治疗前两组患者的JOA评分差异无显著性意义（P〉0.05）,但治疗后两组的JOA评分、平均改善率以及优良率差异均有显著性意义（P均〈0.05）,观察组优于对照组。在治疗后并发症发生率方面,两组差异无显著性意义（P〉0.05）。提示与前路椎体次全切除减压治疗相比,采用后路椎板切除植骨内固定修复长节段颈椎后纵韧带骨化症可以获得良好的效果。     

下颈椎前路内固定联合后路经关节金属螺钉置入固定的生物力学稳定性

背景：对退变性颈椎管狭窄单纯采用前路椎体次全切除或椎间盘切除或单纯后路单开门椎管扩大成行均不能彻底完成脊髓减压和脊柱三柱稳定。目的：探讨下颈椎前路固定联合后路经关节螺钉固定的生物力学稳定性。方法：正常成人尸体颈椎标本,每具分别制作以下两种模型：①经后路C3～C7单开门和下颈椎前路C5椎体次全切除钛网支撑植骨、ORION内固定模型（对照组）。②经后路C3～C7单开门和经关节螺钉内固定及下颈椎前路C5椎体次全切除钛网内植骨、ORION内固定模型（实验组）。结果与结论：实验组在前屈、后伸、左、右侧屈及左、右旋转移位角度均小于对照组（P〈0.001）。提示：①在生物力学实验中,下颈椎前路固定联合后路经关突节螺钉固定的生物力学性能优良,对抗前屈、后伸、左、右旋转的作用力更强,颈椎可获得更可靠的稳定性。②下颈椎前路固定联合后路经关节螺钉固定在对抗颈椎前屈运动时力学稳定性更为强大。     

Numerical investigation of the relative effect of disc bulging and ligamentum flavum hypertrophy on the mechanism of central cord syndrome

BackgroundThe pathogenesis of the central cord syndrome is still unclear. While there is a consensus on hyperextension as the main traumatic mechanism leading to this condition, there is yet to be consensus in studies regarding the pathological features of the spine (intervertebral disc bulging or ligamentum flavum hypertrophy) that could contribute to clinical manifestations.MethodsA comprehensive finite element model of the cervical spine segment and spinal cord was used to simulate high-speed hyperextension. Four stenotic cases were modelled to study the effect of ligamentum flavum hypertrophy and intervertebral disc bulging on the von Mises stress and strain.FindingsDuring hyperextension, the downward displacement of the ligamentum flavum and a reduction of the spinal canal diameter (up to 17%) led to a dynamic compression of the cord. Ligamentum flavum hypertrophy was associated with stress and strain (peak of 0.011 Mpa and 0.24, respectively) in the lateral corticospinal tracts, which is consistent with the histologic pattern of the central cord syndrome. Linear intervertebral disc bulging alone led to a higher stress in the anterior and posterior funiculi (peak 0.029 Mpa). Combined with hypertrophic ligamentum flavum, it further increased the stress and strain in the corticospinal tracts and in the posterior horn (peak of 0.023 Mpa and 0.35, respectively).InterpretationThe stenotic typology and geometry greatly influence stress and strain distribution resulting from hyperextension. Ligamentum flavum hypertrophy is a main feature leading to central cord syndrome.     

颈椎管扩大成形术治疗颈脊髓过伸性损伤

目的 探讨颈椎管扩大成形术治疗颈脊髓过伸性损伤的临床效果.方法 治疗46例颈脊髓过伸性损伤患者,对其中28例行颈椎管扩大成形术（手术组）,18例行非手术治疗（非手术组）,总结并比较治疗效果.结果 随访6～24个月,颈脊髓损伤神经功能恢复按Frankel分级,手术组有效率（85.71%）明显高于非手术组（66.67%）,差异有显著性（P＜0.05）,手术组比非手术组疗效满意.结论 对颈脊髓过伸性损伤患者,行颈椎管扩大成形术可取得较好的治疗效果.     

无骨折脱位儿童新鲜颈脊髓损伤的保守治疗

背景:无放射影像异常颈脊髓损伤为脊髓损伤的一种特殊类型。由于处于生长发育阶段的儿童在解剖学和生物力学方面的特殊性,其损伤机制及治疗方法与成人的有所不同。目的:探讨儿童新鲜无放射影像异常颈脊髓损伤的临床特点及治疗。设计:回顾性分析及自身前后对照观察。单位:哈尔滨医科大学附属第二医院脊柱外科。对象:1997-06/2003-06哈尔滨医科大学附属第二医院脊柱外科收治的无放射影像异常颈脊髓损伤患者14例。纳入标准:①临床表现为不同程度的感觉、运动及括约肌功能障碍。②颈椎X射线平片、MRI检查,未发现骨折脱位。MRI检查显示脊髓损伤征象,T1WI脊髓增粗,T2WI沿脊髓长轴分布条状形高信号区,并向上下蔓延。脊髓完全性损伤患者3例,不完全性损伤11例。在脊髓不完全性损伤中,6例表现为中央脊髓损伤综合征,3例为脊髓半切损伤综合征,2例为前脊髓损伤综合征。方法:对14例儿童无放射影像异常颈脊髓损伤患者进行回顾性分析,采取非手术治疗13例,颈后路寰枢椎融合术1例。主要观察指标:患者治疗前后ASIA分级情况。结果:死亡1例,13例获平均3年随访。无明显改善者3例,其余患者肢体功能均有不同程度的恢复。根据ASIA分级标准,治疗前A级者3例,B级者5例,C级者5例,D级者1例。治疗后恢复至B级者1例,C级者2例,D级者5例,E级者2例。结论:儿童无放射影像异常颈脊髓损伤神经功能恢复情况与脊髓原发性损伤程度密切相关,多数患者以非手术治疗为主,对存在颈椎明显不稳患者可采用手术治疗。     

后路广泛减压侧块螺钉固定治疗无骨折脱位长节段颈髓损伤

【目的】探讨无骨折脱位型长节段颈髓损伤的损伤机制以及后路广泛减压侧块螺钉内固定手术的治疗效果。【方法】对31例无骨折脱位型长节段颈髓损伤的患者,其中先天性颈椎管狭窄和继发性颈椎管狭窄的颈脊髓损伤共25例（80．65％）;伴后纵韧带钙化3例（9．68％）;伴多节段颈椎间盘突出2例（6．45％）,采用后路广泛减压侧块螺钉内固定手术治疗,观察脊髓功’能的变化及评价其临床疗效。【结果】31例术后随访3～17个月,平均9个月,术静ASIA评分平均为96．63±6．4分,术后3周ASIA评分平均为158．53±12．4分,术后3个月ASIA评分平均为18i．68±12．6分,术前和术后两者有统计学显著性差异（P〈0．05）,术后两者无统计学显著性差异（P〉0．05）。除2例术后脊髓功能无改善外,其余患者均有不同程度恢复。【结论】颈椎椎管狭窄是无骨折脱位型颈髓损伤的重要原因;作用因素有惯性作用和直接外力;后路广泛减压侧块螺钉内固定手术能获得较理想的脊髓功能恢复效果。     

后路减压侧块螺钉置入内固定治疗颈椎多节段后纵韧带钙化：5年36例资料回顾

背景：后路减压侧块螺钉固定能够解除骨化灶对脊髓、神经根的压迫,扩大椎管矢状径,同时重建该区域的稳定。目的：验证应用后路减压、侧块螺钉置入内固定治疗颈椎多节段后纵韧带骨化症5年36例资料的临床疗效。方法：36例患者为3个节段9例,4个节段20例,5个节段7例。结果与结论：随访6～26个月,JOA评分由内固定前平均5.2分提高到10.2分。颈椎生理曲度由内固定前平均（3.6±0.5）mm提高到内固定后（9.1±0.7）mm,内固定物无松动。提示此方法治疗既能后方直接减压又能前方间接置入减压,既能恢复颈椎生理曲度,又能提供坚强的内固定效应。     

椎管扩大成形术对脊髓型颈椎病肢体功能障碍的改善

Background:The treatment of cervical spondylopathy have two ways,front and posterior decompression operation.But the operation by front route only apply in the cases of 1～ 2 segments of vertebral canal,and the operation by posterior route can cause the compression of posterior spinal cord and lead to dysfunction of limbs more worse.The plastic operation of enlarging vertebra canal can relieve the pressure of spinal cord and avoid re- stenosis of vertebral canal.     

Evolution of spinal cord injuries due to cervical canal stenosis without radiographic evidence of trauma (SCIWORET): a prospective study

BackgroundTraumatic spinal cord injuries on cervical canal stenosis represent a steadily increasing pathology, of which clinical and functional outcomes remain largely unknown.Material and methodsWe present the results of a prospective study of 20 patients followed for one year who had presented with traumatic spinal cord injury involving initially acute neurological symptoms and cervical canal stenosis defined in the imaging by a Torg ratio < 0.8 and a medullary canal ratio > 0.65, without vertebral fracture.ResultsTraumatic spinal cord injuries on cervical canal stenosis are caused mainly by falls in the elderly population and by unsafe behaviour among younger subjects. Most of the patients present with initially incomplete tetraplegia, and two thirds have centromedullary syndrome. Association of complete tetraplegia with advanced age would seem to be a predictive factor of death in the early post-traumatic period. For incomplete tetraplegics, the main phase of neurological and functional recovery is observed over the first six months. Radiological data and timing of surgery do not appear to affect the prognosis.ConclusionThis study underlines the need for individualized specialized care of patients with spinal cord injuries on cervical canal stenosis, particularly according to their demographic and lesional characteristics.     

颈椎后纵韧带骨化症的CT表现

目的探讨颈椎后纵韧带骨化症（OPLL）的CT表现及其诊断价值。方法回顾性分析2004年11月2009年10月收治的6480例颈椎患者的CT图像资料,观察后纵韧带骨化块的形态、位置及与椎管的关系,计算椎管狭窄率。结果 6480例颈椎CT图像中,37例发现OPLL,占0.57%（37/6480）。颈椎后纵韧带骨化块表现为点状、条状、线状、平板状、山丘状、蕈伞状及花边状,呈现局限型、节段型、连续型、混合型特点。C4、C5及C6为颈椎后纵韧带骨化常见位置。骨化块平均厚度为4.12mm,骨化块致椎管矢状径狭窄率为10.20%～49.18%,多位于椎管前方中间位置。椎管狭窄率〉34.10%,临床症状明显。结论 CT检查能较好地显示颈椎后纵韧带骨化块的特征及椎管的狭窄程度,是临床医生选择手术方案和术后评估预后的一种较好方法。     

中央型脊髓损伤患者术后脊髓功能恢复特征:11例分析

背景颈段脊髓损伤的治疗有多种方式,但效果均不十分理想.目的探讨手术等综合治疗对颈椎中央型脊髓损伤患者术后功能恢复的影响.设计前后对照设计.单位一所大学医院的骨科病房.对象1999-01/2003-01江苏省人民医院骨科共收治中央型脊髓损伤患者11例,均为男性,年龄36～65岁,交通事故9例,跌伤1例,头部砸伤1例,病程2 h～14 d,伴颈椎间盘突出9例,颈椎管狭窄1例,C6椎体骨折1例.MRI片单处损伤9例,两处损伤2例.方法伤后4～20 d手术治疗,9例行前路颈椎间盘摘除植骨加钢板内固定,2例行颈椎后路减压植骨加侧块钢板内固定.主要观察指标①患者手术前后Frankel分级.②手术后脊髓功能恢复结果.结果11例患者术前Frankel分级为0级3例、Ⅰ级3例、Ⅱ级5例.术后为0级1例、Ⅲ级4例、Ⅳ级6例.平均肌力恢复2～5级,复查内固定牢靠、在位,植骨愈合良好.结论颈椎中央型脊髓损伤一旦确诊提倡以手术为主的综合性治疗措施,手术尽可能去除致病因素,其他辅助措施则以促进脊髓功能恢复为目的.     

大鼠腰、颈段脊髓神经元间联系的c-fos基因研究

目的：应用c-fos基因研究腰段和颈段脊髓神经元之间的联系。方法：成年雄性SD大鼠20只，钳夹左侧坐骨经神，灌注取材后行c-fos免疫组化染色。结果：在腰段L4-6脊髓中，钳夹诱发的c-fos基因表达均在钳夹同侧脊髓灰质内，脊髓灰质前角神经元和后角神经元中的c-fos基因表达明显增多，对照侧右侧脊髓中的神经元c-fos基因未见明显表达。在颈段C5-8脊髓中．双侧脊髓灰质前角中可见c-fos基因表达明显增多．双侧脊髓灰质后角中未见明显c-fos基因表达。结论：颈段脊髓和腰段脊髓神经元之间存在着神经纤维联系。     

颈后路个体化精确椎管横径测量在椎管扩大成形治疗椎板定位中的意义

背景：颈后路单开门椎管扩大成形传统方法采用术中解剖标志定位,定位较模糊,且容易受患者个体差异及术者经验的影响。目的：观察颈后路个体化精确椎管横径单开门椎管扩大成形治疗颈椎病的疗效。方法：2006-01/2009-12共施行颈后路个体化精确椎管横径单开门椎管扩大成形治疗119例,对单开门术式进行了部分改进,行个体化椎管横径测量法的单开门椎管扩大成形治疗。观察临床疗效并比较治疗前后和随访时的JOA评分和目测类比评分。结果与结论：共112例患者获得随访,随访时间15~53个月。JOA评分治疗后6个月、末次随访时与治疗前比较显著升高（P〈0.01）。末次随访时疗效分级,优57例,良43例,优良率89.3%。目测类比评分治疗后6个月、末次随访时与治疗前比较显著下降（P〈0.01）。仅有3例患者治疗后出现C5神经根麻痹症状,发生率为2.67%。提示颈后路个体化精确椎管横径单开门椎管扩大成形治疗颈椎病减压彻底,脊髓后移充分,手术方法简单规范,治疗后C5神经根麻痹和颈肩痛症状发生较少。     

不同时期颈椎病患者颈椎骨密度变化与椎体变形关系

目的:通过对颈椎病患者X线和颈椎骨密度的测量,探讨不同年龄段颈椎病患者颈椎椎体变形与骨密度变化之间的关系。方法:分3组,正常组20例,平均年龄23岁;颈椎间盘突出症组(颈椎组)22例,平均年龄43岁,腰椎骨密度正常;骨质疏松合并颈椎管狭窄症组(疏松组)28例,平均年龄58岁,腰椎骨密度显示骨质疏松。所有病例测量颈椎侧位C3～C6的椎管、椎体矢状径比,椎体变形指数,C4～C6骨密度。数据进行统计学处理。结果:与正常组相比,颈椎组患者仅在C5,C6椎体出现轻度椎管狭窄,椎体变形,骨密度无明显变化;疏松组则是颈椎高度减低,周径增宽,骨密度升高,3值之间有明显的相关性。结论:椎体骨质疏松的发展与颈椎病的自然发展病程具有明确的相关性,可能是颈椎开始退变进而发展为颈椎病的始动因素之一。     

Prolotherapy-induced Cervical Spinal Cord Injury - A Case Report -

A 49-year-old man received prolotherapy in the upper cervical region at a local medical clinic. Immediately after the procedure, he felt a sensation resembling an electric shock in his right upper and lower extremities, and continuously complained of numbness and discomfort in the right hemibody. He visited our clinic a week later. Upon physical examination, there were no significant abnormal findings. The visual analog scale was 60 points. T2-weight magnetic resonance images of the cervical spine showed a 0.7 cm sized bright oval spot on the right side of the spinal cord at the level of C4-C5 disc, suggesting spinal cord injury. There were no definite electrodiagnostic abnormalities. Digital infrared thermal images showed moderately decreased surface temperature on lateral aspect of the right forearm and dorsum of the right hand compared with the other side. Considering that very rare complications like spinal cord injury may develop after prolotherapy, we suggest that special interventions such as prolotherapy be performed by professional experts.     

陈旧性颈髓损伤的MRI改变及意义

对24例陈旧性颈髓损伤患者进行MRI检查,并对其中23例采取了手术治疗。通过对颈髓损伤的MRI影像和手术治疗结果分析,探讨了陈旧性颈髓损伤的MRI改变及其意义。结果表明,MRI可显示陈旧性颈髓损伤的部位和程度,其改变与脊髓损伤的病理变化一致,对治疗方法选择和预后判断具有重要意义。