脊髓型颈椎病患者的排尿功能障碍及术后近期效果

目的:探讨脊髓型颈椎病患者产生排尿障碍的影响因素及其术后近期的改善情况。方法:对51例脊髓型颈椎病患者的病程、首发症状、合并症进行分析,并按术前脊髓功能状况评分分组观察术前、术后排尿功能和尿流率改变。结果:51例中术前有排尿障碍者27例（529％）,术后近期症状改善19例（70.4％）;术前尿流率异常者29例（56.9％）,术后最大尿流率较术前显著增加。病程超过1年、以下肢症状起病、合并颈椎OPLL及脊髓功能评分低的患者易出现排尿障碍和尿流率异常。结论:上述因素易造成脊髓型颈椎病患者发生排尿功能障碍;术后近期其排尿功能障碍可获得显著改善。     

影响脊髓型颈椎病远期预后的相关因素分析

目的:探讨年龄、病程、MRI(脊髓受压程度、髓内信号)和皮层体感诱发电位(cortical somatosensory e-voked potential,CSEP)变化对脊髓型颈椎病(cervical spondylotic myelopathy,CSM)手术预后的影响。方法:选择颈前路减压植骨整合钛制带锁螺钉钢板固定治疗的28例CSM患者进行回顾性分析。年龄35～71岁,平均49.6岁;病程4个月～2年,平均18个月。分别依患者的年龄、病程、MRI(脊髓受压程度及有无信号异常)和CSEP等因素进行分组,根据日本矫形外科学会(JOA)制定的脊髓功能评分标准评价患者术后脊髓功能状态,分析各因素与脊髓型颈椎病手术预后的关系。结果:随访1.5～3年,平均2.3年。年龄>60岁与年龄≤60岁术后JOA评分差异有统计学意义(P<0.05),病程>6个月与病程≤6个月术后JOA评分差异有统计学意义(P<0.05),脊髓受压<1/3与脊髓受压≥1/3者术后JOA评分差异有统计学意义(P<0.05),MRIT2加权像和T1加权像信号正常者与T2加权像高信号者术后JOA评分差异有统计学意义(P<0.05),T2加权像高信号、T1加权像信号正常者与T2加权像高信号伴T1加权像信号减弱者术后JOA评分差异有统计学意义(P<0.01),CSEP正常者与异常者术后JOA评分差异无统计学意义(P>0.05)。结论:观察患者的年龄、病程、脊髓受压程度、髓内有无信号异常有助于预测CSM脊髓功能的预后,而不能仅依CSEP判断脊髓的功能状态。     

皮层体感诱发电位与脊髓型颈椎病患者脊髓功能相关性

目的研究皮层体感诱发电位(cortical somatosensory evoked potentials,CSEP)与脊髓型颈椎病(cervical spondylitic myelopathy,CSM)患者脊髓功能的相关性。方法 2008年7月—2012年5月在本院诊断为CSM的患者67例。记录CSM患者CSEP与颈段脊髓传导功能的相关指标,包括N13、N20潜伏期,N9~N20、N9~N13峰间潜伏期(interpeak latency,IPL),P13~N13、P20~N20峰-峰值(peak-peak amplitude,PPA)。记录患者日本骨科学会(Japanese Orthopaedic Association,JOA)评分。将CSEP记录值与JOA评分关系绘制成散点图,当观察到点分布有直线趋势,进行直线相关分析。结果 N9~N13 IPL与JOA评分呈显著负相关。N13潜伏期和N9~N20 IPL与JOA评分呈负相关。结论 N9~N13 IPL与CSM患者脊髓功能障碍程度显著相关,可作为CSM患者脊髓功能评估的电生理指标。     

下肢静脉曲张行浅静脉手术对深静脉瓣膜功能影响的研究

目的：探讨下肢浅静脉手术改善深静脉瓣膜功能的程度及影响效果的因素。方法：收集住院行浅静脉手术治疗的下肢原发性深静脉瓣膜功能不全的患者60例（70条肢体）, 术前经双功能彩色多普勒超声检查记录深静脉血流动力学指标。浅静脉手术后6个月进行随访, 行超声复查, 比较手术前后深静脉瓣膜功能。 结果：下肢浅静脉手术后深静脉瓣膜功能的总体改善率为65.7%；病程超过20年较之病程小于或等于20年的患者改善不佳的可能性高4.355倍；股浅静脉和腘静脉同时存在倒流的患者比两静脉各自单独存在倒流的患者改善不佳的可能性高4.247倍；年龄大于60岁比年龄小于或等于60岁的患者改善不佳的可能性高3.516倍；股浅静脉和腘静脉瓣膜功能改善的程度差异无显著性（P＞0.05）。 结论：下肢静脉曲张单纯行浅静脉手术可在一定程度上改善深静脉瓣膜功能, 手术近期效果好, 可有选择性地应用于某些早期深静脉瓣膜功能不全的患者。     

颈后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病疗效分析

目的探讨颈后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病的疗效及影响因素。方法对76例多节段脊髓型颈椎病患者行后路单开门椎管扩大成形术,术前术后进行JOA评分及Hirabayashi改善率评分。结果 76例均获随访,时间6～36(24.6±10.2)个月。JOA评分:术前为9.5分±2.41分,术后为12.92分±1.69分(P<0.05)。术后患者神经功能有不同程度的改善,末次随访改善率为54.60%±15.52%。结论颈后路单开门椎管扩大成形术能有效地解除脊髓的压迫,改善神经功能,疗效肯定。年龄、病程、术前JOA评分对脊髓功能改善率影响显著,年龄越大、病程越长、术前JOA评分越低的患者,术后脊髓功能改善越差。     

前后路手术治疗脊髓型颈椎病的分析

目的分析脊髓型颈椎病（CSM）前后路手术的疗效和特点。方法对105例CSM术后患者，按JOA评分系统行术前和术后的神经功能分析：结果随访时间平均为36个月（20～80个月），术后54例前路减压植骨内固定患者48例明显改善，而后路椎管成型术51例患者中42例症状改善明显。结论前后路手术对早期CSM的治疗均取得良好的治疗效果，但随时间的延长（即晚期）其手术治疗效果也下降。晚期患者脊髓损害时间愈长手术治疗效果愈差。术前症状持续的时间与术后恢复程度有明显的相关性。     

脊髓型颈椎病患者脊髓MRI T2WI高信号的危险因素

目的:探讨脊髓型颈椎病(CSM)患者脊髓MRI T2WI高信号的危险因素。方法 :2014年1月~2014年4月因CSM于我院骨科行手术治疗的185例患者被纳入研究。将脊髓MRI T2WI高信号分为3级:0级,无高信号;1级,T2WI有模糊而边界不清的高信号,且高信号范围局限于一个节段;2级,T2WI有明亮而边界清晰的高信号或高信号范围超过一个节段。在MRI T2WI横断位上测量脊髓压迫程度,在过伸、过屈位X线片上测量颈椎节段和整体活动度。对可能影响高信号的因素(性别、年龄、病程、术前mJOA评分、脊髓压迫程度、颈椎活动度、椎间盘退变程度)行单因素分析,挑选出有意义指标(P0.1)行有序Logistic回归分析。结果:脊髓MRI T2WI高信号的发生率为72.4%。按照分级标准,0级51例(27.6%),1级86例(46.5%),2级48例(25.9%)。性别和脊髓压迫程度对高信号的影响有统计学意义(女性相对于男性的OR=0.366,脊髓压迫比值的OR=0.904,P0.05),而年龄、病程、术前mJOA评分、椎间盘退变程度、颈椎活动度与高信号均无明显相关性(P0.05)。结论:男性、脊髓压迫程度重为CSM患者脊髓MRI T2WI高信号的独立危险因素。     

动态颈椎MRI对脊髓型颈椎病的研究进展

颈椎MRI对脊髓型颈椎病(cervical spondylotic myelopathy,CSM)诊断价值毋庸置疑,但是不少学者发现:多数CSM患者脊髓压迫重,临床症状也重,但有些患者脊髓压迫程度较轻而临床症状较重,也有些患者脊髓压迫程度较重而临床症状较轻.为何出现CSM患者的临床表现和影像学检查不一致的现象?纵观国内常规拍摄的颈椎MRI不难发现:传统的仰卧位颈椎MRI不能全面地、彻底的评估脊柱及其内部脊髓正常或异常状态.人类的自然状态包括承重状态下的躯体状态和复杂的动态姿势,目前,常规颈椎MRI的检查设备没有考虑这些因素.而动态或承重颈椎MRI技术能很好的观察颈椎的退行性变:隐蔽的负重性疾病(例如,局灶性椎间盘突出、脊柱椎管狭窄)以及运动依赖性疾病(例如椎间盘突出、椎管狭窄、动力性不稳定).因此,动态颈椎MRI相对常规颈椎MRI能较早发现CSM病理性改变,就此,查阅国内外近期相关文献,将动态颈椎MRI对CSM的早期诊断和治疗价值的研究进展作如下综述.     

腓骨截骨治疗膝骨性关节炎的近期效果研究

目的 :探讨腓骨截骨手术对膝骨性关节炎患者的近期临床治疗效果。方法 :自2015年1月起,收治以内侧间隙疼痛为主要表现的膝骨性关节炎患者12例(15膝);均为女性患者,平均年龄61.3岁。均采用腓骨截骨手术,对其膝骨性关节炎进行治疗。术后早期下地适当进行关节活动,对患者手术前后进行相应影像学评估,测量膝关节内外间室高度变化情况。观察并记录术前、术后2 d、术后2个月VAS、KSS、HSS评分,分析各项指标变化情况。结果:患者住院天数(6.0±2.4)d;单侧手术时间(33.3±8.4)min,术中均无明显出血。术后均未出现伤口感染、延迟愈合及神经损伤等并发症。所有患者于术后1 d下地行走,主诉原有膝关节内侧间隙疼痛明显好转或消失。患者手术后2 d与术前相比,VAS、HSS及KSS临床评分均较术前改善;手术后2个月与术前相比,VAS、HSS、KSS临床评分及功能评分均较术前改善。术后2 d复查膝关节负重位X线片,与术前膝关节负重位X线片比较,均出现不同程度膝关节内侧间隙增高。结论:腓骨截骨术手术操作简单,创伤小,术后疼痛减轻明显,关节功能恢复良好,是治疗骨性关节炎膝内翻的有效方法。     

脊髓损伤合并截肢患者的康复效果分析

目的:探讨脊髓损伤合并截肢患者的康复治疗效果。方法:1991年～2011年共收治脊髓损伤合并截肢者6例,ASIA分级A级5例,C级1例;右下肢截肢者3例,左下肢截肢者1例,左上肢截肢者1例,右下肢与右上肢截肢者1例,均进行康复评价并确定康复方案。在患者全身情况和残肢关节活动度获得改善后,对截瘫合并下肢截肢者予穿戴假肢和矫形器行站立和行走训练,合并上肢截肢者予佩戴功能性假肢等康复治疗。经过物理治疗(PT)、作业治疗(OT)训练及佩戴相应的假肢和矫形器,并经过反复训练和强化后观察康复效果。应用脊髓损伤神经学分类国际标准(ASIA标准)评估患者神经功能,使用功能独立性评定(FIM)量表评估患者生活自理能力。结果:本组病例平均住院康复时间为126d(58~236d)。5例截瘫患者ASIA神经功能无明显改善(P>0.05),但FIM运动评分显著提高(入院得分为25.83分,出院平均得分为52.17分)(P<0.05)。另1例颈脊髓损伤患者入院为不完全损伤,经过治疗后感觉评分提高58分,运动评分提高14分,FIM评分中自理活动能力提高9分,转移能力提高14分,运动能力提高5分。结论:脊髓损伤合并截肢患者经过佩戴假肢并予综合康复后,患者丧失的部分功能可得到替代,生活自理能力可得到明显提高。     

Surgical treatment for cervical spondylotic myelopathy associated with athetoid cerebral palsy

There have been several reports on surgical interventions in patients with adult cervical spondylotic myelopathy associated with athetoid cerebral palsy; however, the long-term effectiveness of these interventions has not been demonstrated. We have performed surgical treatments — posterior fusion with wave-shaped rods and anterior interbody fusion with internal fixators — in 20 patients. The present study included 17 of these patients, 16 men and 1 woman, and their mean follow-up period was 8.6 years (range, 5–15.5 years). One year after surgery, walking ability was improved in 14 patients. Pain in the upper extremities and muscle weakness of the deltoid were alleviated in all patients. One patient showed recurrence of myelopathy after 8.5 years' follow-up. Our surgical technique is effective in patients with cervical spondylotic myelopathy secondary to athetoid cerebral palsy, even in those with severe involuntary movements. Postoperative rigid external fixations are not required. Received: July 27, 1999 / Accepted: March 7, 2000     

The value of somatosensory- and motor-evoked potentials in predicting and monitoring the effect of therapy in spondylotic cervical myelopathy. Prospective randomized study.

STUDY DESIGN: A 2-year follow-up prospective randomized electrophysiologic and clinical study of patients with spondylotic cervical myelopathy. OBJECTIVE: To assess the value of somatosensory- and motor-evoked potentials in the evaluation and prediction of the effect of therapy. SUMMARY OF BACKGROUND DATA: Previous studies have yielded conflicting data concerning the correlation between the changes in evoked potential parameters and the clinical postsurgical outcome in spondylotic cervical myelopathy. METHODS: Sixty-one patients with magnetic resonance images suggesting spondylotic cervical cord compression and clinical signs of cervical myelopathy were divided into two groups according to the degree of clinical cervical cord involvement. The 49 patients with mild and moderate spondylotic cervical myelopathy were randomized into groups that underwent either surgical or conservative therapy. Patients were evaluated clinically and by the means of somatosensory- and motor-evoked potentials. RESULTS: The clinical and evoked potential changes showed good correlation on the group level, but poor correlation intraindividually. There were no significant evoked potential and clinical group changes after 6 months and 2 years in the mild myelopathy group treated either surgically and conservatively, whereas patients with severe myelopathy displayed significant improvement in clinical and evoked potential parameters after surgery. In a subgroup of patients, the isolated segmental medullar N13 abnormality could potentially predict favorable postsurgical clinical outcome. CONCLUSIONS: Longitudinal evoked potentials showed limited use for evaluating the results of therapy in an individual patient. They could be useful in the group assessment of therapy results and in labeling a subgroup of patients with potentially favorable postsurgical outcome.     

Long-term results of double-door laminoplasty for cervical stenotic myelopathy

STUDY DESIGN: A retrospective study of the long-term results from double-door laminoplasty (Kurokawa's method) for patients with myelopathy caused by ossification of the posterior longitudinal ligament and cervical spondylosis was performed. OBJECTIVE: To know whether the short-term results from double-door laminoplasty were maintained over a 10-year period and, if not, the cause of late deterioration. SUMMARY OF BACKGROUND DATA: There are few long-term follow-up studies on the outcome of laminoplasty for cervical stenotic myelopathy. METHODS: In this study, 35 patients with cervical myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine and 25 patients with cervical spondylotic myelopathy, including 5 patients with athetoid cerebral palsy, underwent double-door laminoplasty from 1980 through 1988 and were followed over the next 10 years. The average follow-up period was 153 months (range, 120-200 months) in patients with ossification of the posterior longitudinal ligament and 156 months (range, 121-218 months) in patients with cervical spondylotic myelopathy. Neurologic deficits before and after surgery were assessed using a scoring system proposed by the Japanese Orthopedic Association (JOA score). Patients who showed late deterioration received further examination including computed tomography scan and magnetic resonance imaging of the cervical spine. RESULTS: In 32 of the patients with ossification of the posterior longitudinal ligament and 23 of the patients with cervical spondylotic myelopathy, myelopathy improved after surgery. The improvement of Japanese Orthopedic Association scores was maintained up to the final follow-up assessment in 26 of the patients with ossification of the posterior longitudinal ligament and 21 of the patients with cervical spondylotic myelopathy. Late neurologic deterioration occurred in 10 of the patients with ossification of the posterior longitudinal ligament an average of 8 years after surgery, and in 4 of the patients with cervical spondylotic myelopathy, including the 3 patients with athetoid cerebral palsy, an average of 11 years after surgery. The main causes of deterioration in patients with ossification of the posterior longitudinal ligament were a minor trauma in patients with residual cervical cord compression caused by ossification of the posterior longitudinal ligament and thoracic myelopathy resulting from ossification of the yellow ligament in the thoracic spine. CONCLUSIONS: The short-term results of laminoplasty for cervical stenotic myelopathy were maintained over 10years in 78% of the patients with ossification of the posterior longitudinal ligament, and in most of the patients with cervical spondylotic myelopathy, except those with athetoid cerebral palsy. Double-door laminoplasty is a reliable procedure for individuals with cervical stenotic myelopathy.     

脊髓型颈椎病对男性勃起功能影响的临床分析

目的:探讨脊髓型颈椎病对男性性功能的影响及手术后性功能的恢复情况。方法:通过前瞻性随访22例男性患者,均因脊髓型颈椎病伴有性功能障碍接受手术治疗,术后随访平均16个月。手术前后的神经功能按照JOA评分标准,性功能评定采用勃起功能相关指数(IIEF-5),同时对手术前后患者反射性勃起和心理性勃起的情况进行对比研究。结果:大多数患者术后神经功能明显好转,术后JOA评分比术前提高(13.50±1.22vs9.64±1.87,P<0.01)。正常反射性勃起手术前后比较有显著性差异(95%vs82%,P<0.05),正常心理性勃起手术前后比较有显著性差异(91%vs18%,P<0.01),术后多数患者性功能明显好转,平均IIEF-5指数由术前的9.90±2.22提高到术后的20.89±3.89,两者差异显著(P<0.01)。结论:除了神经功能障碍外,脊髓型颈椎病也可导致性功能障碍,大多数表现心理性勃起异常而反射性勃起正常。术后随着神经功能的恢复,多数患者性功能也得以好转。     

The Torg--Pavlov ratio in cervical spondylotic myelopathy: a comparative study between patients with cervical spondylotic myelopathy and a nonspondylotic, nonmyelopathic population

STUDY DESIGN: A radiologic study to compare the Torg--Pavlov ratios between patients with cervical spondylotic myelopathy and a nonspondylotic, nonmyelopathic population. OBJECTIVES: To determine and compare the Torg--Pavlov ratios between the two groups of patients. SUMMARY OF BACKGROUND DATA: Patients with congenital cervical spinal canal stenosis are more likely to develop cervical spondylotic myelopathy. The Torg--Pavlov ratio eliminates errors related to magnification, a problem with determination of spinal canal stenosis from direct measurements of plain cervical spine radiographs. There has only been one other study that directly compares the Torg--Pavlov ratio between patients with cervical spondylotic myelopathy and a normal control population. METHODS: The preoperative plain lateral cervical spine radiographs of 28 patients with cervical spondylotic myelopathy requiring surgical decompression were compared with radiographs of 88 nonspondylotic, nonmyelopathic patients. The Torg--Pavlov ratio was computed for each level from C3 to C7. RESULTS: The study showed that the Torg--Pavlov ratio is significantly smaller (P < 0.001) in myelopathic patients (mean 0.72 +/- 0.08) compared with the control patients (mean 0.95 +/- 0.14). This was so when individual levels and the mean values were compared. Age was also found to be a significant factor (P = 0.002), although lesser in magnitude when compared with the Torg--Pavlov ratio (P = 0.0001). CONCLUSIONS: The Torg--Pavlov ratio is significantly lower in patients with cervical spondylotic myelopathy compared with a nonspondylotic, nonmyelopathic population. It could possibly be used to predict the likelihood of developing cervical spondylotic myelopathy.     

前路钛钢板加钛网植骨内固定治疗多节段脊髓型颈椎病作用评价

目的：探讨前路钛钢板加钛网植骨内固定治疗多节段脊髓型颈椎病的效果及意义，方法：总结1998年至2002年期间收治的25例有2-3个节段突出的脊随型颈椎病行前路椎体次全切术前路钛钢板加钛网植骨内固定术，结果：经平均12个月的随访，25例患者植骨全部融合，无钛网移位脱落，无螺钉松动，钢板断裂，神经功能得到了不同程度恢复。结论：应用前路钛钢板加钛网植骨内固定术治疗有2-3个节段突出的脊髓型颈椎病是安全有效的。     

Preoperative instability does not influence the clinical outcome in patients with cervical spondylotic myelopathy treated with expansive laminoplasty

Sixty-seven patients with cervical spondylotic myelopathy treated with expansive laminoplasty were retrospectively reviewed at a minimum 2-year follow-up. This study was designed to evaluate whether preoperative instability influences the clinical outcome in patients with cervical spondylotic myelopathy treated with laminoplasty without spinal fusion. Patients with preoperative instability were older and had shorter durations of symptoms prior to surgery than those without the instability. There were no significant differences in prevalence of axial symptoms, neurologic recovery, or radiologic findings between patients with and without preoperative cervical instability. At follow-up, the cervical range of motion was limited to 43.5% of the preoperative range, and no cervical instability was observed in any patients. Preoperative instability does not influence the clinical outcome and can be ignored if expansive laminoplasty is indicated for patients with cervical spondylotic myelopathy.     

Late stress fracture of a well-incorporated autologous fibula strut graft in the cervical spine: a case report

Four-level corpectomy for cervical spondylotic myelopathy presents special challenges to successful outcomes. At our institution, where the senior author has performed over 300 multilevel corpectomies with autologous fibula reconstruction, only 11 four-level procedures have been performed. It is important to consider the length of time required for complete revascularization of these long strut grafts as well as unusual postural or gait biomechanics the patient may have. Patients with altered gait or trunk stability who require anterior surgery for cervical spondylotic myelopathy may be best served by concurrent posterior fusion. We report a case in which a patient with cervical spondylotic myelopathy and diplegic cerebral palsy developed a stress fracture in the midportion of his well-incorporated autologous fibula strut graft 1 year after it was placed following four-level corpectomy.     

Cervical posterior fusion with wave-shaped rod under local anesthesia for cervical spondylotic myelopathy: review of 12 patients.

STUDY DESIGN: Clinical evaluation of cervical interspinous fusion under local anesthesia in elderly patients with cervical spondylotic myelopathy. OBJECTIVES: To evaluate the effectiveness of cervical posterior fusion with wave-shaped rods inserted under local anesthesia for elderly high-risk patients with cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: A substantial number of patients cannot undergo surgical interventions under general anesthesia because of their general medical complications. Although such patients would become unable to walk, which might induce a worsening of their general condition, conservative treatments had been adopted as the only treatment for these patients. The authors have obtained satisfactory results by means of posterior interspinous fusion under local anesthesia even in the high-risk patients with severe cervical spondylotic myelopathy. The aims of this surgical technique were to adjust cervical alignment and to stabilize the motion segment(s) without decompression. PATIENTS AND METHODS: Between May 1989 and August 1998, 12 elderly patients (3 men and 9 women) with cervical spondylotic myelopathy were treated with posterior interspinous fusion using wave-shaped rods inserted under local anesthesia. The average age at the surgery was 76.9 years. The average follow-up period was 5 years 6 months. All patients were unable to walk without any assistance because of their advanced myelopathy. It was felt that all of them would be unable to accept general anesthesia because of their generally poor medical conditions. Preoperative severity of the clinical symptoms and postoperative recovery were evaluated by a scoring system proposed by the Japanese Orthopaedic Association, which had 17 points at full mark. RESULTS: The average duration of the surgical procedure was 122.8 minutes. The average total blood loss was 118.6 g. No instrument failures were denoted. Neither neural deterioration nor major complication was observed relating to the surgery. Radiographic bony union of the grafted bone was achieved in all patients. Progression of myelopathy was arrested in all 12 patients, and clinical symptoms were improved in 10 patients. The mean Japanese Orthopaedic Association scores had increased from 5.0 to 10.2 points. CONCLUSIONS: Twelve high-risk patients with cervical spondylotic myelopathy were treated with posterior interspinous fusion using wave-shaped rods inserted under local anesthesia. This method was evaluated as an effective surgical salvage without any mortal complications even in the elderly high-risk patients.