颈椎侧块螺钉系统内固定术联合椎板减压术治疗颈椎管狭窄症疗效观察

目的观察颈椎侧块螺钉系统内固定术联合椎板减压术治疗颈椎管狭窄症的疗效。方法颈椎管狭窄症患者32例,其中瘫痪6例,不能行走26例,肌力1～4级。Frankel分级：C级6例,D级24例,E级2例。均行侧块螺钉系统内固定术,采用Margel法植入螺钉,其中侧块钢板固定12例,侧块钉棒固定20例,根据椎管狭窄和不稳节段切除相应椎板。结果术后随访6～36个月。X线片示螺钉位置正常,颈椎骨性融合,稳定性恢复,未见颈椎不稳。Frankel分级：C级6例中2例恢复至D级、4例恢复至E级,D级24例均恢复至E级,E级2例无变化。所有患者均下地行走;术后肌力3～5级,无轴性症状、内固定松动等并发症。结论采用颈椎侧块螺钉系统内固定术联合椎板减压术治疗颈椎管狭窄症疗效较好。     

65岁以上老年人腰椎管狭窄症手术治疗的临床分析

目的 探讨老年人腰椎管狭窄症手术治疗的可靠性、手术方法及手术后效果。方法 回顾性分析1990年1月至2005年6月我院收治的65岁以上老年腰椎管狭窄症患者304例，其病程3~360个月，平均139．2个月，手术方法主要为单纯全椎板切除减压术、多节段椎板开窗减压术、全椎板及侧隐窝神经根管减压＋椎弓根螺钉固定术＋椎体间或（和）横突间植骨术。结果 术后264例恢复良好或优，优良率86．8％；34例感觉与术前比，变化不大；有6例较术前加重；无术中死亡患者。结论 老年患者多病程长、术前各种并存症多，掌握手术适应证应慎重，术前详细检查并积极地处理并存症、多科共同协作是手术成功的关键。手术应在充分的减压基础上尽量减少损伤，最短时间完成手术，根据实际合理的内固定促进植骨融合。术后积极的功能锻炼、早期的下床活动是保证手术效果、减少术后并发症的关键。     

颈椎后纵韧带骨化行后路椎板成形术减压需考虑后纵韧带厚度

为了评估颈椎后纵韧带骨化患者行椎板减压术对颈髓压迫的影响,Seichi A等采用术中超声扫描技术检测了颈髓受压情况（J Neurosurg Spine 2010,13：47—51）。该研究纳入了因颈椎后纵韧带骨化造成的颈椎脊髓病患者40例,均行颈椎双开门椎板减压术治疗,减压后应用术中彩超评估颈髓位置。     

单开门椎板成形椎管扩大术在老年颈椎管狭窄治疗中的可行性

目的探讨单开门椎板成形椎管扩大术在老年颈椎管狭窄治疗中的可行性。方法 75例颈椎管狭窄症患者按照术式分为对照组(n=37)与观察组(n=38),分别采用全椎板切除加侧块内固定手术与单开门椎板成形椎管扩大术进行治疗。比较两组患者手术前后Frankel评分与JOA评分、手术前后生活质量评分、术后并发症发生情况。结果两组患者术后Frankel评分与JOA评分均显著高于术前(P0.05~0.01),且观察组患者术后上述评分均显著高于对照组(P0.05)。两组患者术后SF-36生活量表各维度(躯体功能、心理功能、社会功能及物质功能)评分均显著高于术前(P0.05),且观察组患者术后上述各维度评分均显著高于对照组(P0.05)。对照组术后并发症总发生率为37.84%(14/37),显著高于观察组(13.16%,5/38)(P0.05)。结论单开门椎板成形椎管扩大术治疗老年颈椎管狭窄的临床疗效显著,具有一定的可行性。     

重度氟骨症腰椎管狭窄症及手术治疗

我科1987年以来,治疗氟骨症患者120例,确诊为重度氟骨症腰椎管狭窄者40例,30例接受了椎板切除减压手术治疗,均收到了较满意的效果,报告如下。     

颈椎椎管成形术治疗多节段颈椎管狭窄

<正>多节段颈椎管狭窄的原因有很多,其中最为常见的是颈椎病或后纵韧带骨化(ossification of posterior longitudinal ligament,OPLL)。椎管减压既可以前路进行,也可以选择后路进行。对于多节段病变,尤其伴有OPLL患者,由于手术安全性的考虑,其手术方案倾向于采用后路减压。后路颈椎减压手术包括椎板切除术和椎管成形术,其中以椎管成形术最为常用,根据椎管成形减压方式差异,其主要术式分为2大类:单开门与双开门椎管成形     

多节段退变性腰椎管狭窄症手术治疗的疗效观察

目的探讨多节段退变性腰椎管狭窄症手术治疗疗效。方法自2005年3月～2009年10月,采用广泛椎板减压椎弓根螺钉内固定、椎间融合和后外侧融合或椎管钛网成形治疗多节段腰椎管狭窄症患者46例。术后平均随访3.7 a,应用JOA评分(29分法)对手术前后临床疗效进行主客观评价。结果术后患者JOA评分较术前有显著提高(P均<0.01)。术后半年优良率86.9%。结论采用广泛椎板减压椎弓根螺钉内固定、椎间融合和后外侧融合或椎管钛网成形治疗多节段退变性腰椎管狭窄症,可取得满意和持久的临床疗效。     

老年颈椎后纵韧带骨化症患者后路术式疗效比较

目的比较后路全椎板间接减压内固定植骨融合术与后路单开门椎管成形术两种术式治疗颈椎后纵韧带骨化(OPLL)症老年患者的疗效。方法共有47例患者入选,男27例,女20例,平均年龄(65.7±8.3)岁,随访时间6月至3年。上述OPLL症患者按照手术术式分为椎管成形术组与椎板减压术组。记录2组患者年龄、性别、手术时间、术中出血量、日本骨科协会(JOA)评分(术前、术后1周、末次随访)、视觉模拟量表(VAS)评分(术前、术后1周、末次随访)、JOA评分改善率以及VAS评分改善率,比较两种手术术式疗效差异。结果椎管成形术组入选患者29例,全椎板减压术组患者18例。2组患者在手术时间、出血量、术后VAS评分及改善率指标上均存在显著性差异(P<0.05),其余指标2组间未见显著性差异(P>0.05)。结论虽然颈椎后路全椎板减压术可以早期较好地减轻老年OPLL症患者颈项部疼痛症状,但2种术式远期疗效相近,且颈椎后路椎管成形术具有手术时间、术中出血少等优势,因此,建议老年OPLL症患者应尽可能首选颈椎后路椎管成形术治疗。     

保留椎板复合结构瓣治疗老年腰椎管狭窄症

在腰椎管狭窄的老年患者中，相当一部分患者具有手术指征，但由于病人的生理机能减退，全身疾病多，手术的耐受性降低，临床上往往被迫采取保守治疗，从而造成患者的生活质量下降。我院采用保留椎板及后韧带复合结构瓣回植治疗老年腰椎管狭窄症患者60例，重建了腰椎生物力学的完整性和稳定性，有效地防止术后下腰椎不稳定和医源性腰椎管狭窄等并发症的发生。     

老年退行性腰椎管狭窄症82例手术治疗体会

目的探讨手术治疗老年退行性腰椎管狭窄症（DLSS）的临床效果。方法对同期收治的82例DLSS患者于针对性治疗并发内科疾病后行手术治疗,根据病情分别选择椎板开窗减压、髓核摘除、黄韧带切除、侧隐窝及神经根管扩大术,半椎板切除减压并侧引窝扩大术、全椎板切除减压术等。观察手术一般情况并随访判定疗效。结果手术时间平均1．5h,出血量平均240ml,术中无1例因出现意外而终止手术,住院时间平均18d;67例获平均随访14个月,疗效为优25例、良31例、无变化8例、差3例,优良率84％。结论在加强围手术期处理及选择合适手术方案前提下,手术治疗老年DLSS临床效果确切、安全性较高。     

全椎板切除减压椎弓根固定后外侧植骨融合术治疗腰椎管狭窄症

目的探讨后路全椎板切除减压椎弓根固定后外侧植骨融合术治疗腰椎管狭窄症的临床效果。方法2002年1月喇8年6月我院收治的腰椎管狭窄症患者55例,手术方法为后路全椎板切除减压术＋椎弓根螺钉固定术＋后外侧植骨术。结果所有病例均得到随访,平均36个月（6-72个月）,47例优或良,6例可,2例差。优良率85．5％。结论后路全椎板切除减压椎弓根固定后外侧植骨融合术治疗腰椎管狭窄症临床效果肯定。     

老年颈椎管狭窄并发脊髓病的外科治疗

目的：探讨老年颈椎管狭窄并发脊髓病的外科治疗结果及围手术期并存病的处理原则,方法：分析15例病人临床表现,颈椎X线动力性拍片及MRI病理改变,围手术期并存病控制及手术疗效。结果：6例椎板成形和8例推板减压者均获得优良疗效,并存病控制得当,无并发症发生,结论：老年颈椎管狭窄并发脊髓病是退变,骨质疏松和颈椎不稳等多因素所致,年龄不是禁忌手术治疗的金标准,控制好围手术期并存病,颈椎后路手术疗效是令人满意的,由于老年骨质疏松,椎板成形易失败。     

Correlation between the ossification of nuchal ligament and clinical cervical disorders

This is a correlation analysis between severity of the ossification of the nuchal ligament (ONL) and clinical cervical disorders including neck dysfunction, cervical malalignment, and morphologic changes of the cervical neural foramen (CNF). The clinical effects of ONL on active range of motion (AROM) of neck, cervical radiculopathy, abnormal cervical curvature, and the degree of CNF stenosis in patients with painful neck stiffness are investigated. Studies have investigated the predisposing factors to cervical dysfunction and degenerative disorders; however, few studies have examined the influence of the ONL on neck function and cervical spine. A total of 31 participants with painful neck stiffness were recruited. They accepted measurement of cervical AROM and serial cervical radiographs at anterior–posterior view, lateral view, and bilateral oblique views. Parameters of radiographs measurement included cervical lordotic curve, and cross-sectional areas (CSA) of the ONL and CNF (C2–C3, C4–C5, C5–C6, and C6–C7 levels). The ratio of CSA of the lower CNF (C4–C5, C5–C6, C6–C7) to CSA of the upper CNF (C2–C3) was used as a CNF stenosis ratio. The correlations of ONL size, neck symptoms, cervical AROM, lordotic curve, and CNF stenosis ratio were analyzed. More than half of all patients were positive in cervical root signs and prone to have larger ONL. Neck AROM of all participants was significantly below normal average in all directions, and a moderate negative association was found between the ONL CSA and AROM in flexion–extension. Most patients had moderate loss of cervical lordotic curve despite there being no significant correlation between ONL CSA and cervical curvature. Moreover, CNF stenosis ratio significantly negatively correlated with ONL CSA. Patients with larger ONL had more severe cervical radiculopathy, more stiffness in flexion–extension direction, more complex degenerative change of spine, and worse CNF stenosis.     

Lumbar and cervical stenosis. Frequency of the association,role of the ankylosing hyperostosis

Summary The authors report a study of 47 patients admitted for cervical myelopathy (N=17) or symptomatic lumbar spinal stenosis (N=30). Nine patients had clinical evidence of coexisting cervical myelopathy and lumbar spinal stenosis. Ten out of the 17 patients having cervical myelopathy had lumbar spinal stenosis as evidenced by saggital tomography and/or computerized tomography. Nine out of the 30 patients admitted for symptomatic lumbar spinal stenosis had coexisting cervical canal stenosis as evidenced by sagittal tomography. Thirteen out of these 19 patients with both cervical and lumbar canal stenosis had also ankylosing spinal hyperostosis.     

Differences between men and women undergoing major orthopedic surgery for degenerative arthritis

Objective. To determine whether women have worse functional status than men at the time of laminectomy for degenerative spinal stenosis or total joint arthroplasty for degenerative arthritis of the hip and knee. Methods. Consecutive patients undergoing laminectomy for degenerative lumbar spinal stenosis or unilateral, primary hip or knee arthroplasty for advanced degenerative arthritis were recruited. Functional status was measured with self-administered questionnaires. We compared preoperative functional status scores of men and women, using linear regression models that adjusted for age, comorbid conditions, work status, education, living arrangement, and body mass index. We also compared the rates of in-hospital complications and 6-month followup functional status scores for men and women. Results. Women had much worse functional status than men prior to laminectomy for spinal stenosis (P < 0.01) and prior to total hip arthroplasty (P < 0.001) and total knee arthroplasty (P < 0.0001). These differences persisted after statistical adjustment for demographic and clinical characteristics. Women had comparable or greater functional improvement following surgery and experienced a similar number of complications compared with men. Conclusions. The observed gender differences in functional status prior to major orthopedic surgery indicate that women are operated on at a more advanced stage in the course of their disease. These results are not due to gender differences in demographic or clinical characteristics of the patients, and cannot be justified by differences between men and women in the outcome of surgery. The role of patient preferences and differential access to these procedures should be explored in future studies.     

Electrocardiographic changes after cervical laminectomy

Striking T-wave inversions were observed in the postoperative electrocardiograms of a 64-yr-old woman following an extensive cervical laminectomy. Except for the presence of a trace amount of CK-MB in a single serum specimen all her enzyme and isoenzyme studies were negative, and her clinical course was not suggestive of myocardial ischemia. Coronary angiography, including an ergonovine study, done 6 mth following the laminectomy were normal. Because of the nature of this patient's surgery and the paucity of evidence for the presence of organic heart disease a neurogenic origin of these T-wave changes is suspected.     

辽宁省地方性氟中毒的流行和防治现状

目的 了解辽宁省地方性氟中毒(简称地氟病)流行现状和防治措施落实情况.方法 对改水和未改水饮水型地氟病病区分层抽样开展饮用水含氟量筛查和8-12岁儿童氟斑牙,16岁以上成人临床氟骨症病情普查,检测8-12岁儿童志愿者尿氟.结果 全省普查842个未改水村(屯)和1829个改水村(屯),未改水村(屯)居民饮用水水氟0.01-7.10 mg/L,平均(0.96±0.64)mg/L,29.2%(246/842)的未改水村(屯)饮用水含氟量＞1.2 mg/L,在1829个改水村(屯)中调查了1234个降氟改水工程,水氟0.06-7.67 mg/L,工程正常运行且水氟≤1.2 mg/L的工程占调查工程的68.31%(843/1234),已改水村(屯)有31.69%(391/1234)的工程没有发挥其降氟改水作用.普查12127名8-12岁儿童和85 636名16岁以上成人,儿童氟斑牙检出率为24.4%(2960/12 127),成人临床Ⅱ度及以上氟骨症检出率为2.22%(1900/85 636).轻,中,重病区儿童氟斑牙检出情况比较,差异有统计学意义(X2＝19.25,P＜0.01),重病区儿童氟斑牙检出率较高,个别未改水的重病区村(屯)儿童氟斑牙检出率达到100%,成人临床Ⅱ度及以上氟骨症检出率为18.03%(97/538).重病区和轻病区(未改水及工程报废)儿童尿氟中位数分别为2.01,2.00 mg/L.结论 辽宁省未改水的饮水型地氟病中,重病区的病情仍然十分严重,工程停运或报废病区仍亟须落实降氟改水防治措施.     

Primary hyperparathyroidism presenting as cervical myelopathy

Quadriplegia as a presenting syndrome in a case of primary hyperparathyroidism is reported. The clinical picture was misdiagnosed as a space-occupying lesion in the cervical spinal canal, for which an unnecessary laminectomy was performed. The neurologic deficits disappeared following the removal of a parathyroid adenoma. The neurologic presentations of hyperparathyroidism are reviewed and discussed.     

Fluorosis in primary dentition in a region with endemic water fluoride

OBJECTIVE: The aim of the present study was to estimate the prevalence of dental fluorosis in primary dentition of a San Luis Potosi children population, and its association to fluoride concentration in drinking water and urine. An additional objective was, to develop, validate, and test a specific index for dental fluorosis in primary dentition. MATERIAL AND METHODS: From May 1997, to January 1999, we conducted a cross-sectional study to assess the prevalence of dental fluorosis in primary dentition. Study subjects were 100 children aged 3-6 years, selected at random from three kindergartens in three risk areas of San Luis Potosi. The specific index of dental fluorosis for primary dentition (Dental Fluorosis for Primary Dentition Index--DFPDI) was validated by estimating fluoride concentrations in enamel of teeth with and without dental fluorosis. The Kruskal-Wallis test was used to assess the association between fluoride concentrations in drinking water and urine, with dental fluorosis; the association between risk area and dental fluorosis was assessed with the Mantel-Haenszel chi 2 test. RESULTS: The prevalence of dental fluorosis in primary dentition was 78%; primary molars were most affected in both maxillae and the predominant color was a non-glossy white appearance. We found a strong direct correlation (r = 0.93) between fluoride concentrations in primary teeth and the DFPDI. Associations were found between fluoride concentrations of drinking water and urine, with dental fluorosis (Kruskal-Wallis p = 0.00001), and between risk area and dental fluorosis (Mantel-Haenszel chi 2 p = 0.00001). CONCLUSIONS: DFPDI allowed adequate identification and grading of dental fluorosis in primary dentition. It is important to detect the initial toxic effects of fluoride exposure to predict dental fluorosis in permanent dentition and skeletal fluorosis.     

2006年广西地方性氟中毒防治项目调查结果分析

目的 了解广西地方性氟中毒病区分布和改水降氟工程现状,掌握广西地方性氟中毒病情状况.方法 2006年按照国家(2005年中央补助地方公共卫生专项资金地方病防治项目技术实施方案>,对广西地方性氟中毒分布地区和改水降氟工程进行水氟监测和病情调查.水氟测定采用氟离子选择电极法,儿童氟斑牙采用Dean诊断分度法检查,氟骨症按全国氟骨症临床分度诊断标准判定.结果 共筛查了61个村屯305份水样,超标71份,超标率为23.28%.检测了8处降氟改水工程,除1处工程报废外,其余工程水氟均未超标.调查了8～12岁儿童2627人,检出氟斑牙356人,检出率为13.55%;调查16岁以上成人1615人,检出Ⅱ度以上氟骨症患者65人,检出率为4.02%.结论 广西地方性氟中毒防治形势仍然十分严峻,须进一步加强改水降氟等防治措施.