寰齿关节在颈椎斜扳手法中安全性问题的力学研究

目的：研究颈椎斜扳法下寰齿关节的安全性。方法：运用生物力学中的电测技术,设计了一种斜扳模拟装置,采用7具新鲜尸体颈椎标本,对寰齿关节在不同生理病理状态,拔伸与非拔伸条件下的接触应力进行观察,结果：斜扳时局部接触应力在拔伸状态,生理状态和病理失稳状态下之比为1：1．2：9．4。正常生理状态下斜拆,后伸位应力大于前屈位而小于自然中立位。结论：颈椎斜扳时患者头部以微屈位为最好,同时施加一定拔伸力,对颈椎存在严重退变失稳的患者,应减小旋转的幅度和力量。     

The optimum spine

System theory is used to describe the mechanism of the lumbar spine. The role of the spine in vertebrate evolution is presented. The importance of the intervertebral joint for the survival of the species is shown to be crucial. The mechanical behavior of the joint is derived, and from this the corresponding spinal motion and muscular responses is calculated. It is shown that physiologic behavior implies that the stress at the intervertebral joints is equalized and minimized. From this simple condition, the motion of the spine in the sagittal plane is calculated. From the analysis of sagittal plane motion together with a knowledge of the energy transfer through the intervertebral joint, a new theory of locomotion is derived. This theory of locomotion differs in important respects from current theories, but nevertheless explains available experimental data. This unified theory of the function of the human spine permits the determination of the level of safe loads that can be lifted and transported. It predicts the conditions of load transfer through a joint. It proposes a new approach to the mechanism of arthritis and to the repair of fractures.     

The cervical spine involvement in patients with psoriatic arthritis

Psoriatic arthritis (PsA) is a systemic disease and cervical spine can be affected. The data regarding cervical spondylitis are very rare and diverse in literarture. The aim of study was to assess the prevalence of cervical spine involvement in patients with PsA. Between totally 41 patients with PsA we confirmed the incidence of 68% (29 patients) with symptomatic cervical spine disease and 29% (12 patients) with radiological evidence of inflammatory involvement. The most frequent radiological findings were apophyseal joint changes, rarely ligamentous calcification and syndesmophytes. Only one patient had subaxial subluxation. The most common type of PsA was axial disease with or without peripheral arthritis (46%) and the least common was oligoarthritis (22%). There was no statistically significant difference between any type of PsA and cervical involvement. CONCLUSION: inflammatory cervical spine changes are not common radiographic finding in patients with PsA and apophyseal joint affection is the most common radiologic sign.     

Influence prediction of injury and vibration on adjacent components of spine using finite element methods

OBJECTIVES: A three-dimensional finite element (FE) model of the lumbar spine L3-L5 segment, the ligaments of which were assumed to be nonlinear materials, was established based on the actual vertebra geometry to investigate the influence of the injury lumbar spine on its adjacent components on the condition of whole-body vibration. Several injury conditions of the spine components were assumed, such as facetectomy, nucleotomy, and removal of bony posterior elements. METHODS: The dynamic FE analyses were carried out for those FE conditions under cyclic compression loads at the frequencies of 5 and 10 Hz. Then a comparison between the dynamic results and the static results was conducted to analyze the influence of both the nucleus injury and the facet joint injury on the adjacent intervertebral discs. RESULTS AND CONCLUSIONS: The results indicate that the lumbar spine exhibits not only vertical vibration but also the flexion--extension motion during vibration. The denucleation will cause high stress and large disc bulge on the disc annulus under vibration. The facet joints of lumbar spine can limit the motion amplitude of flexion-extension and protect both the posterior regions and the posterolateral regions of disc annulus from large strain and stress during vibration. The facet joint removal will increase the stress of disc annulus by around 15% at the posterior region for the conditions of nucleotomy or no vibration. The stress of annulus circumference is higher at the posterolateral region than that of other regions of annulus circumference, and the facet joint removal may exacerbate the intervertebral disc degeneration on the condition of whole-body vibration.     

Herausforderungen und Besonderheiten der Spondylodiszitiden der Halswirbels?ule

The human cervical spine is a unique structure that differs dramatically from the thoracic and lumbar spine. The main differences concern the topographic anatomy of the spinal cord, anatomy and physiology of the occipito-atlanto-axial joint complex, the close course of the vertebral artery to the cervical spine and the very close relationship of the esophagus, vessels, peripheral and cranial nerves to the spine. To avoid serious complications during surgical treatment of spondylodiscitis within the cervical spine, these aspects must be kept in mind. They will be explained in detail in this article.     

Morphological changes of cervical facet joints in elderly individuals

To better understand the role of facet joint degeneration in chronic neck and back pain epidemiological and morphological data are needed. For the cervical spine, however, such data are rare. Therefore, the aim of this study was to determine the degree of cartilage degeneration of cervical facet joints with respect to spinal level and age, to investigate whether any region of the joint surface is more often affected by degeneration and to determine the localisation of osteophytes. A total of 128 left-sided facet surfaces from 15 fresh frozen cervical spine specimens (59-92 years) including in maximum C2-C7 were inspected in a way to ensure a direct comparability to data reported for the lumbar spine. First, the macroscopic degree of cartilage degeneration was determined and correlated to spinal level and age. Then, each facet surface was divided into five regions (anterior, posterior, lateral, medial and central) to check whether cartilage degeneration occurs more often in any of these regions. Finally, the localisation of osteophytes was determined. The results showed that the mean degree of cartilage degeneration was 2.8 (+/-0.6) on a scale from Grade 1 (no degeneration) to 4 (severe degeneration). None of all 128 facet surfaces was classified as Grade 1. All spinal levels had about the same degree of degeneration (in mean 2.5-3.0). The youngest age group (<70 years) had a somewhat lower degree of degeneration (2.6) than the oldest (> or = 90 years) (3.1). Cartilage defects were found all over the joint surfaces, none of the five regions was more often affected than the others. Least osteophytes were found on the medial border of the facet joints. In conclusion, the prevalence of cervical facet joint degeneration is probably very high in individuals aged 50 years and more, with a tendency to increase in severity with age. All levels of the middle and lower cervical spine were affected to almost the same degree, whereas in the lumbar spine an increase in degeneration towards the lower levels was reported. Also, in the cervical spine in most cases the cartilage was evenly degenerated all over the joint surface while in the lumbar spine certain regions were reported to be affected predominantly.     

The role of magnetic resonance imaging in seronegative spondyloarthritides

Seronegative spondyloarthritides (SpA) is a group of inflammatory rheumatic diseases characterized by inflammation of the sacroiliac joints and/or the spine, enthesitis and peripheral arthritis. MRI is the imaging method of choice for visualization of the sacroiliac joint and spine according to the new ASAS classification criteria for axial SpA. It can visualize both active inflammation and structural damage and is not associated with radiation exposure. MRI findings characteristic for active disease include bone marrow edema and contrast enhancement of the bone marrow and the joint space, while chronic changes include bone erosions, sclerosis, periarticular fatty tissue accumulation, bone spurs and ankylosis. MRI has higher sensitivity comparing to other radiological modalities. MRI.is the most important diagnostic imaging method in early SpA. It is sensitive and reliable for objective monitoring of the disease process and it is essential in the management of patients with SpA.     

Osteoid osteoma

Osteoid osteoma is a relatively frequent benign bone tumour, consisting of osteoid and woven bone, and surrounded by a halo of reactive sclerotic bone, with an average size of the nidus less than 1.5 cm. It is a condition of late childhood, adolescence and young adult age. It usually occurs in the appendicular skeleton and the spine, and is generally localised in or near the cortex. The lesion causes pain, especially at night, but can cause joint pain with synovitis and joint effusion if located in the vicinity of chondral structures, or painful scoliosis if located in the spine. Osteoid osteoma may have an unpredictable course, and may require treatment or resolve spontaneously. In some cases, the diagnostic approach is challenging; there are different treatment methods, some of which have been recently introduced, with promising results. We review the literature about the natural history, clinical presentation, diagnostic approach and classical or modern treatment modalities of osteoid osteoma.     

Sea urchin spine arthritis of the hand

PURPOSE: Although rare, hand injury caused by puncture with the sea urchin spine can result in serious complications. To emphasize its clinical significance, this article describes a group of patients who sustained chronic granulomatous arthritis induced by puncture with sea urchin spine (designated sea urchin spine arthritis). METHODS: Five patients who developed sea urchin spine arthritis of the hand after puncture with sea urchin spine were treated at our hospitals. All lesions involved the proximal interphalangeal (PIP) joint (4 index fingers and 1 middle finger). Patients experienced pain, swelling, and discomfort around the site of puncture immediately after the injury. These initial symptoms subsided within a few days, and secondary symptoms including fusiform swelling, limited motion, and mild pain of the PIP joint appeared from 1 to 2 months later. Laboratory tests of inflammation and blood cell counts were negative. Plain radiographs showed soft tissue swelling and osteolysis but no visible spine. Thorough synovectomy of the PIP joint was performed, and the granulation tissue around the joint was also removed. RESULTS: No microorganism was identified from tissue culture or polymerase chain reaction in any of the 5 patients. At a mean follow-up of 21 months, 2 patients exhibited essentially normal active motion of the affected PIP joint, whereas the remaining 3 patients had diminished range of motion. CONCLUSIONS: Diagnosis of sea urchin spine arthritis can be made by history of sea urchin spine injury, a symptom-free period before the development of synovitis, and the absence of laboratory test abnormalities. Neither antibiotics nor nonsteroidal anti-inflammatory agents are effective. Undertaken early enough, thorough synovectomy might avoid complications and obtain favorable results. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

Orion钢板固定后对植骨块及小关节突应力影响的实验研究

目的:研究单纯植骨及植骨+Orion钢板内固定后对植骨块及相邻椎节小关节突应力的影响。方法:采用8具男性新鲜颈椎标本,分别行单纯植骨及植骨+Orion钢板内固定后测量植骨块及相邻椎节小关节突应力的变化。结果:单纯植骨时融合节段上小关节突的应力无明显增加,而植骨+Orion钢板内固定后则显著增加。单纯植骨及植骨+Orion钢板内固定后融合节段下小关节突的应力无明显增加。植骨+Orion钢板内固定后植骨块的应力较单纯植骨时变小。结论:植骨+Orion钢板内固定后融合节段上小关节突的应力明显增加,容易造成融合上节段的退变,并且存在一定的应力遮挡,故在治疗单纯颈椎退行性病变的患者时,使用Orion钢板内固定应持谨慎态度。     

Predominant cervical involvement in patients with psoriatic arthritis: report of two cases

Cervical spine involvement is common but usually delayed in patients with psoriatic arthritis. We report two cases with early and predominant involvement of the upper cervical spine. Synovitis of the atlanto-odontoid joint and fusion of multiple facet joints were noted in one patient. In the other patient, the main finding was atlanto-axial subluxation with erosions of the odontoid process and anterior arch of C1. No abnormalities were noted in the peripheral joints, sacroiliac joints, or thoracolumbar spine. Analgesics and conventional antiinflammatory agents were only minimally effective. TNFalpha antagonist therapy (infliximab followed by etanercept) in one patient and phenylbutazone therapy in the other improved the symptoms and led to shrinkage of the pannus.     

Telangiectatic osteosarcoma of the spine: a case report

Telangiectatic osteosarcoma (TOS) of the spine is rare accounting for only 0.08% of all primary osteosarcomas. Though a well described radio-pathological entity it is not often thought of as a cause of paraplegia. We describe the clinical, radiological and pathological features and discuss the treatment options of telangiectatic osteosarcoma of the dorsal spine presenting in a young man. The diagnostic pitfalls are discussed emphasising the fact that the diagnosis of TOS of the spine requires not only a multi modal approach of appropriate radiological and pathological tests but also an awareness of this condition.

     

Facet joint cysts causing cauda equina compression

Facet joint cysts are commonest at the L4-L5 level and are associated with facet joint degeneration and type III (degenerative) spondylolisthesis. It is extremely rare for facet joint cysts to cause symptomatic cauda equina compression. Three elderly patients presented to us with significant cauda equina compression caused by facet joint cysts. One presented with classic symptoms and signs of a cauda equina syndrome, a second with bilateral lower limb neurologic loss associated with uncontrolled epilepsy, and the third with bilateral leg symptoms as well as an upper limb tremor and fasciculation. The diagnosis was easily made after magnetic resonance scanning in two patients, although in one patient, it was significantly delayed because of his confounding neurologic picture. Lumbar spine surgery (decompression and cyst resection) was successful in resolving symptoms in all three, even though two patients had significant neurologic compromise before surgery. The occurrence of facet joint cysts in older patients can be associated with other degenerative neurologic conditions, and the diagnosis might not be apparent early. We suggest that in older patients who have a mixed picture of central and peripheral neurologic compromise, this diagnosis should be considered and investigation of the whole of the spine, not just the brain and spinal cord, should be undertaken.     

Gymnastic injuries

The gymnast often places unphysiologic extreme stresses upon her body during the maneuvers characteristic of that sport. These may result in stress fractures to the skeleton, the lumbar spine being at greatest risk. Minor malalignments of the extremities can encourage injury. The extremes of joint position can produce significant symptoms with chrondromalacia.     

Ankylosing spondylitis: recent breakthroughs in diagnosis and treatment

Ankylosing spondylitis (AS) is generally easy to diagnose when the characteristic findings of the "bamboo" spine and fused sacroiliac joints are present on radiographs. Unfortunately, these changes are usually seen late in the disease after tremendous suffering has been incurred by the patient. Diagnostic delay averages seven to ten years. Historically, once the diagnosis was made, the treatment options were often inadequate or poorly tolerated in many individuals. This condition most often starts in early adulthood when people are typically in the earlier stages of their careers, resulting in diminished workforce participation and decreased quality of life. If an individual has a family physician, this might be the first encounter with a healthcare provider. Quite often, the initial practitioner is sought at a public walk-in clinic or chiropractic office. In recent years, there have been two major developments in the management of AS that make earlier diagnosis possible and offer the hope of alleviating pain and preventing structural changes that result in loss of function. These developments include the use of magnetic resonance imaging (MRI) to visualize the inflammatory changes in the sacroiliac joint and the axial spine, and the demonstration that tumor necrosis factor (TNF) blocking agents are highly efficacious in reducing spinal inflammation and possibly in slowing radiographic progression. This review outlines diagnostic strategies that can help identify AS in its earlier stages. Special attention is focused on treatment advances, including the use of anti-TNF agents, and how these medications have been incorporated into clinical recommendations for daily use.     

Vertebral collapse and normal peripheral blood cell count at the onset of acute lymphatic leukemia in childhood

Acute lymphatic leukemia presenting with bone pain and spine involvement is a recognized clinicopathologic complex that can mimic a wide range of orthopaedic conditions. Bone pain as the presenting complaint is common, with a reported incidence of 27% to 50%. Radiologic abnormalities associated with leukemia in children has been described previously. In the literature, the incidence of spinal involvement is controversial, but there is agreement that the spine is less commonly involved than are the long bones. At the onset of the disease, only 10% of children have normal peripheral blood counts. If the patient has spinal involvement and a normal leukocyte count, the diagnosis is often unclear. Only three of these patients have been described in the literature; this article adds one more patient with acute lymphatic leukemia with back pain as the main symptom, vertebral collapse, and a normal peripheral blood cell count at the time of initial presentation. It illustrates that delay in diagnosis frequently occurs, with the classic features of the disease being uniformly absent.     

Spondylarthrose an der Halswirbelsäule

Chronic neck pain is often associated with spondylarthrosis, whereby segments C4/C5 (C: cervical) are most frequently affected. Spondylarthrosis can be the sole complaint, but it is associated with a degenerative cascade of the spine. The umbrella term for neck pain is the so-called cervical syndrome, which can be differentiated into segmental dysfunction and/or morphological changes of the intervertebral discs and small joints of the vertebral column. Conservative therapy modalities include physical therapy, subcutaneous application of local anesthetics, muscle, nerve and facet joint injections in addition to adequate analgesic and muscle relaxant therapy. If surgery is required, various techniques via dorsal and ventral approaches, depending on the clinic and morphologic changes, can be applied.     

Pain patterns in adult scoliosis

Adult patients with scoliosis often have back pain, but that pain may or may not be due to the curvature. A careful history, physical examination, routine radiographic examination, and, on some occasions, specialized radiographs, CT, myelography, discography, and facet joint injection will help the physician or surgeon separate out those pain syndromes owing to the curvature versus those not owing to the curvature. Only after these critical evaluations have been done can a decent decision be made as to the area of the spine to be treated, either surgically or nonsurgically.     

Biomechanical testing of an artificial cervical joint and an anterior cervical plate

An in vitro biomechanical study was conducted to determine the effects of fusion and nonfusion anterior cervical instrumentation on cervical spine biomechanics in a multilevel human cadaveric model. Three spine conditions were studied: harvested, single-level artificial cervical joint, and single-level graft with anterior cervical plate. A programmable testing apparatus was used that replicated physiologic flexion/extension and lateral bending. Measurements included vertebral motion, applied load, and bending moments. Relative rotations at the superior, implanted, and inferior motion segment units (MSUs) were normalized with respect to the overall rotation of those three MSUs and compared using a one-way analysis of variance (P < 0.05). Application of an anterior cervical plate decreased motion across the fusion site relative to the harvested and artificial joint spine conditions. The reduced motion was compensated for by an increase in motion at the adjacent segments. Use of an artificial cervical joint did not alter the motion patterns at either the instrumented level or the adjacent segments compared with the harvested condition for all modes of testing.     

Charcot osteoarthropathy in a case of Klippel-Trenaunay-Weber syndrome

A case of a patient with Klippel-Trenaunay-Weber syndrome (KTW) with Charcot osteoarthropathy is presented. A medline literature review was performed using the words Klippel-Trenaunay, orthopaedic, ankle, foot, and Charcot joint. Seven articles reported orthopaedic manifestations of KTW. They included limb hypertrophy and atrophy, limb-length discrepancies, digital anomalies, ulcerations, and spine and hip abnormalities, but no mention of Charcot osteoarthropathy. After many years of chronic nonhealing ulcers and repeated incision and drainage procedures the patient developed Charcot osteoarthropathy of the ankle without evidence of osteomyelitis or peripheral neuropathy but with severe deformity that required transtibial amputation.