颈椎病尸体骨赘模型的设计与建立

目的 为比较不同的手术方法对颈椎病前路骨赘切除范围的影响,特制作本模型.方法 参考临床颈椎病骨赘类型,将人工骨赘粘合于颈椎尸体标本上,建立颈椎病的骨赘模型12具,随机分为处理组和对照组,进行三维重建CT扫描.在CT影像上观察骨赘的影像学表现,并测量两组的椎体后缘骨赘和钩椎关节增生骨赘的数据,对数据进行比较和统计学分析.结果 椎体后缘骨赘和钩椎关节增生骨赘的测量均无明显的差异(P>0.05),并且模型CT表现与临床上颈椎病骨赘增生的影像学表现一致.结论 此模型比较真实地模拟了人的颈椎病增生骨赘的表现,有助于进一步研究和评价不同颈椎病前路手术方法的手术减压效果.     

双侧椎板开窗椎体后缘骨赘切除治疗腰椎管狭窄症

双侧椎板开窗椎体后缘骨赘切除治疗腰椎管狭窄症宋展昭，万年宇应用双侧椎板开窗椎体后缘骨赘切除治疗腰椎管狭窄４例，平均年龄５８岁，平均病程５年６个月。主要表现为间歇性跛行，足背伸肌力下降，小腿和足部麻木，跟腱反射减弱或消失，直腿抬高试验多为阴性。术前造影...     

胸腰椎椎管造影术在胸腰椎骨折内固定术中的应用

目的 探索椎管内造影术在胸腰椎爆裂性骨折内固定术中的应用.方法 对152例胸腰椎骨折在行椎板减压前常规行椎管造影了解伤椎椎体后缘骨块及椎管容积情况,有针对性行椎板减压.结果 经体外及术中内固定的撑开复位,椎体后缘的骨块已基本复位.结论 椎管造影术可减少椎体后柱的再次损伤.     

切除与漂浮后纵韧带在脊髓型颈椎病前路减压术中的疗效对比

目的比较后纵韧带切除与漂浮在单间隙脊髓型颈椎病前路减压术中的疗效。方法对93例行前路减压植骨内固定治疗的单间隙脊髓型颈椎病患者资料进行分析。其中脊髓明显压迫41例(A组),伴有椎体后缘骨赘形成或椎间盘脱出;椎间盘突出压迫为主;无椎体后缘骨赘形成52例(B组)。按照JOA评分分别比较后纵韧带切除与漂浮术后症状的改善率。结果平均随访16个月,A组中行后纵韧带切除与漂浮平均改善率分别为77%和67%,B组分别为75%和74%。结论对于椎体后缘骨赘形成或椎间盘脱出病例切除韧带术疗效优于漂浮术,对于椎间盘突出压迫为主而无椎体后缘骨赘形成者,两者疗效无明显差异。     

后纵韧带切除及潜行减压在脊髓型颈椎病前路手术中的价值

目的评价退变增厚的后纵韧带切除及潜行切除椎体后缘骨赘减压对脊髓型颈椎病（CSM）前路手术疗效的影响。方法同时伴有椎体后缘骨赘增生和后纵韧带退变增厚的脊髓型颈椎病40例，予前路切除退变后纵韧带、潜行骨赘减压，并植骨融合内固定。随访6～36个月，平均14．5月。据JOA评分系统对脊髓功能恢复进行评定比较。结果术前JOA评分：3～13分，平均10．3分。术后6月：11.5～17分，平均15．7分，RIS：32％～100％（76％±20％）。术前与术后6月比较有显著性差异（P〈0．01）。结论切除退变增厚的后纵韧带及潜行切除椎体后缘骨赘减乐可使受压脊髓得到最大限度的减压，可显著提高CSM前路手术的疗效。     

小切口手术治疗腰椎椎体后缘离断症

目的：探讨腰椎椎体后缘离断症的有效手术方法。方法：将腰椎椎体后缘离断症分为侧方型及中央型,采用椎板拉钩法的小切口手术治疗腰椎椎体后缘离断症12例,均为男性;年龄23～40岁,平均30岁;病程17.9个月。侧方型10例,其中离断骨块位于L4椎体后下缘1例,L5椎体后上缘3例,S1椎体后上缘6例,均合并同侧椎间盘突出;中央型2例,离断骨块均位于S1椎体后上缘。侧方型采用单侧椎板间开窗,摘除突出的椎间盘髓核,摘除椎体后缘骨块;中央型采用双侧椎板间开窗,摘除突出的椎间盘髓核,摘除椎体后缘骨块。结果：所有患者获得随访12～36个月,平均22.5个月,按照Macnab术后评定标准：优10例,良2例。结论：小切口手术治疗腰椎椎体后缘离断症具有手术创伤小、操作方便的优点,可完整摘除椎体后缘骨块,是一有效的手术方法。     

腰椎间盘突出症手术失败原因和再手术方法的探讨

目的探讨腰椎间盘突出症手术失败的原因及再手术的时机和方法。方法对腰椎间盘突出症手术失败患者的初次术前诊断、手术方法、再手术前临床表现、影像学检查进行评估。分析初次手术失败原因及再手术治疗的适应证、手术方法、手术入路及疗效。在获得随访的患者中,行开窗、扩大开窗法腰椎间盘摘除术46例,行半椎板切除减压、椎间盘摘除术12例,行全椎板切除减压、椎间盘摘除、神经根管松解术22例,行全椎板切除减压、椎体后缘骨赘及软骨结节切除术16例,行后路经椎弓根螺钉固定、椎管减压、神经通道松解、后外侧植骨或椎间融合术47例。结果143例患者初次手术后获得随访,随访时间24～144个月,平均62个月。再手术后29例出现并发症。采用日本骨科学会(JOA)腰背痛29分评分标准对患者进行评分。患者再手术前JOA评分平均11.3分,术后随访时JOA评分平均24.2分,平均改善率72.9%。结论腰椎间盘突出症再手术的原因包括手术适应证选择不当、多间隙突出遗漏、术中定位错误及髓核摘除不彻底、双侧型或中央型突出只切除一侧、椎体后缘软骨结节未切除、未处理中央椎管狭窄及神经根管狭窄、术后腰椎间盘突出复发、全椎板减压术后腰椎节段性不稳定。正确选择再手术时机及方法仍可以获得较为满意的疗效。     

经椎间隙扩大式潜行减压治疗侧后型骨源性颈椎病

颈椎病患者骨赘增生以椎体后缘和钩椎关节处为主,而很少累及椎体后壁中部。因此,前路手术完全可通过经椎间隙的上下、双侧扩大式潜行减压而达到彻底减压目的.自2006年2月至2008年1月,采用颈椎前路经椎间隙扩大式潜行减压、植骨加钢板内固定术治疗26例侧后型骨源性颈椎病患者,报告如下。     

腰椎椎体后缘离断症

目的 认识腰椎椎体后缘离断症的临床及影像学诊断依据,提出治疗及手术要点。方法 8例腰椎椎体后缘离断症的患者,术前被冠以腰椎间盘突出症合并软骨结节突出4例,后纵韧带骨化2例,2例临床诊断有腰椎椎体后缘离断症的存在,术中均见大小不等的与突出的椎间盘组织并不相连的浮动骨块。结果 8例病人全部手术治疗,术后疼痛症状消失。随访4～18个月,只有2例患者诉残留阴雨天腰部酸痛症状。结论 腰椎间盘突出症的患者在CT扫描见突出物合并有骨化块时,要仔细分析有无腰椎椎体后缘离断的现象。清晰的腰椎正侧位X线片,病椎间隙CT轴位扫描有助于术前诊断。卧床休息,一般不做牵引及推拿,手术宜采取椎板双侧开窗以求完整切除骨块。     

双侧椎板间开窗治疗腰椎间盘突出症伴骨赘形成

1995年至2000年12月,我科共手术治疗腰椎间盘突出症436例,其中伴椎体后缘骨赘形成23例,经施双侧椎板间开窗,髓核摘除,骨赘凿除术,收到较好的治疗效果.     

腰椎后路手术对硬膜囊容量和脊柱稳定性的影响

目的 :进一步了解腰椎后路手术对脊柱功能的影响 ,为临床合理选择术式提供依据。方法 :采用平行光三维测量系统 ,对 12具人新鲜尸体腰椎实施全椎板切除、半椎板切除及交叉半椎板切除 ,对其屈伸状态下硬膜囊容量和脊柱稳定性的定量变化结果进行双因素方差分析。结果 :腰椎屈曲活动时硬膜囊容量增大 ,仰伸位变小 ;全椎板切除与交叉半椎板切除 ,硬膜囊容量改变相近 ,但均较半椎板切除明显增大 (P <0 0 1) ;任何一种腰椎后路手术 ,均能破坏腰椎稳定性 ,其中半椎板切除与交叉半椎板切除破坏性较小 ,而与全椎板切除相比较 ,后者破坏性大于前二者 (P <0 0 1)。结论 :下腰椎疾病后路手术应尽量保留棘突及其韧带 ,交叉半椎板切除可使椎管得到充分减压 ,同时又较好地保留脊柱的稳定性     

Combined posterior and anterior endoscopic supported instrumentation of the thoracic and lumbar spine. Arguments,concepts and first clinical results

The operative therapeutic principles of thoracic and lumbar spine injuries are based on reposition, decompression and stabilization of the unstable area. Secondary loss of correction and consecutive deformation have negative impact on the long-term results after defect fractures of vertebral bodies and will be minimized only by the reconstruction of all involved spinal columns. With dissemination of thoracoscopic techniques at the thoracic spine and minimal invasive retroperitoneal approaches at the lumbar spine a decrease of the morbidity was achieved with equal effectivity for recalibration and fusion. Our experiences with the first consecutive 42 patients, treated minimal invasive are presented. Indications for anterior thoracoscopic and minimal invasive instrumentations after posterior transfixation are remaining osseous defects of the end plates of more than a quarter of the volume of the involved vertebra in case of migration of the vertebral disc, wedging of the vertebral body after posterior reposition of more than 10 degrees and persisting anterior encroachment of the spinal canal of more than 30 %. The decision is based on radiographs and CT-scans, performed after posterior stabilization.     

One-stage approach to the anterior and posterior vertebral column in operative treatment of advanced traumatic and neoplastic changes of the thoraco-lumbar spine]

There were presented indications and operative technique of one-stage approach to anterior and posterior part of the thoraco-lumbar spine. Presented technique gave chance to control antero-lateral and posterior aspects of the spine. There were 2 patients with delayed compressions of the vertebral bodies in lumbar part with severe kyphotic deformity. Those deformities were the cause of progression of neural symptoms in a few months after injury. Another 4 patients had the spinal tumours. In one case it was giant-cell tumour which destroyed body and the arch of Th12. In two patients metastases of renal cancer infiltrated L2 and L3. The last one had breast cancer metastasis into Th12. In all patients it was necessary to control anterior and posterior columns of the spine to restore its axis and the shape of spinal canal.     

腰椎管潜行扩大桥式椎管成形术

传统的全椎板切除减压术治疗腰椎管狭窄症，不仅影响脊柱的稳定性，还可能并发腰椎管继发狭窄．作者采用腰椎管潜行扩大桥式椎管成形术治疗１５例，优良率为９３．４％。本术式特点：１．充分扩大椎管，包括神经根管。２．不破坏脊柱稳定性。３．保持原腰椎活动范围、４．不再形成新的压迫．     

椎管内肿瘤的诊断及手术治疗

探讨椎管内肿瘤的临床特点及手方法。方法１０３例椎管内肿瘤患者均经手术治疗,颈椎行单开门术暴露椎管,胸椎行全椎板切除,腰椎椎则行次全椎板切队鹘椎椎管内外哑铃型肿瘤分别采用颈前路和肋骨横突切除术入路。结果随访８２例平均随访时间３．５年,优良率为８１．７％。     

Partially Overlapping Limited Anterior and Posterior Instrumentation for Adult Thoracolumbar and Lumbar Scoliosis: A Description of Novel Spinal Instrumentation, “The Hybrid Technique”

Progressive and/or painful adult spinal deformity in the thoracolumbar and lumbar spine is sometimes treated surgically by long posterior fusions from the thoracic spine down to the pelvis, especially where there is a major thoracic curve component. Recent advances in anterior spinal instrumentation and spinal surgery technique have demonstrated the improved corrective ability offered by anterior stabilization systems, and the added benefit of limiting the number of vertebral fusion levels required for control of the deformity. The "hybrid technique" is a novel use of anterior instrumentation that applies limited anterior instrumentation down to the low lumbar spine (rods and screws), and partially overlapping short-segment posterior instrumentation to the sacrum (pedicle screws and rods). These constructs avoid posterior thoracic instrumentation and fusions, and avoid extension of posterior instrumentation to the pelvis. In the first 10 patients treated using this technique, thoracolumbar and lumbar major curve correction has averaged 71 and 82% in the immediate postoperative period (n = 7), respectively, and 59 and 68% at 2-year follow-up, respectively. The technique is an appealing and attractive alternative for treatment of thoracolumbar and lumbar scoliosis in the adult population, and avoids the requirement for applying spinal fixation to the thoracic spine and the pelvis.     

Cage and graft options in lateral lumbar interbody fusion

The use of lateral lumbar interbody fusions has shown promise for spine surgeons in achieving successful outcomes from surgery. Lateral lumbar interbody fusion is a minimally invasive approach to the lumbar spine for placement of interbody implants. Insertion of lateral interbody cages preserves the anterior and posterior structural elements while avoiding the major vessels anteriorly and the spinal canal posteriorly. In this review, we evaluate the options in cages and biological grafts used in lateral lumbar interbody fusions     

Two-stage decompression for combined epiconus and cauda equina syndrome due to multilevel spinal canal stenosis of the thoracolumbar spine: a case report

INTRODUCTION: A case of combined epiconus and cauda equina syndrome due to multilevel spinal canal stenosis of the thoracolumbar spine is reported. METHODS: A 76-year-old man with multilevel spinal canal stenosis of the thoracolumbar spine (Th11-12, L2-S) who showed symptoms of epiconus syndrome was reported. First, we performed anterior decompression and fusion at the thoracolumbar junction (decompression: Th11-12, fusion: Th10-L2), which ameliorated his symptom partially. However, he presented cauda equina symptoms. Then, he underwent posterior spinal decompression (L3-5) and fusion (Th12-L5). RESULTS: After anterior decompression, several symptoms disappeared. However, motor and sensory disturbance below L4 and bladder-bowel disturbance remained. We then performed a secondary operation. At three years' follow-up, he was able to walk with the aid of a cane. CONCLUSIONS: Combined epiconus and cauda equina syndrome due to multilevel spinal canal stenosis was treated by combined two-stage anterior and posterior decompression. In this case, multilevel decompression via anterior and posterior approaches was necessary to relieve the symptoms.     

Ossification of the posterior longitudianl ligament of the cervical spine: subtotal vertebrectomy as a treatment.

If the ossification is localized in the central part of the intervertebral space, anterior decompression surgery of Cloward may be indicated. However, if most posterior ligamentous ossification covers the posterior surface of the vertebral body and the lateral sides, Cloward's method is not indicated. We have developed a method of anterior decompression and fusion surgery to clear the ossified area, resecting the vertebral body (subtotal vertebrectomy). The results were excellent in 3 of 4 patients with preoperative radiculopathy; there were 2 excellent and 16 good results in 22 patients with myelopathy. Of course laminectomy can produce some good effects, but the anterior obstruction removes through the anterior approach. Anterior decompression may be indicated when ossification is localized below the C3--4 intervertebral space, and when the spinal canal is not narrowed in the upper cervical region, even if ossification extends over the whole cervical spine. Laminectomy is advised when ossification involves all levels of the cervical spine, the upper cervical spine is narrowed or the sagittal dimension of the spinal canal is reduced more than 60%.     

Therapeutic concept and results of operative treatment in acute trauma of the thoracic and lumbar spine: the Hannover experience

A therapeutic concept for the treatment of acute thoracolumbar spinal injury includes an early closed reduction as the first step. In cases with a surgical indication in the lower thoracic area as well as in the lumbar spine, the posterior approach is preferred. Following decompression of the spinal cord, a transpedicular lifting of the upper endplate is done and the fractured vertebra is filled with corticocancellous bone chips. Stabilization is achieved with an internal fixator usually over two motion segments only. Subsequently, autologous corticocancellous bone is added between lamina and between the transverse processes. In the thoracic spine proper, the anterior approach is more advantageous. Following spondylectomy (removal of the vertebral body whole or in part), an intercorporal spine arthrodesis is performed utilizing a solid bone graft and plates. Seventy-six patients with 78 fractures and subluxations of the thoracolumbar spine were reexamined for an average of 3 years and 4 months after their operation. Of the patients with an incomplete cord injury (Frankel B-D) 60% improved at least one Frankel grade and an additional nine patients improved within their group. Clinical deterioration did not occur. Irrespective of the localization, the radiologically determined loss of correction following an anterior approach was an average of 7 degrees whereas the settling after posterior approach averaged 9 degrees. The sagittal index of the affected vertebra improved from 0.59 preoperatively to 0.80 postoperatively. All spinal arthrodeses healed with osseous reorganization. Twelve postoperative computer tomographies were analyzed (11 after a posterior decompression), and showed a decrease of the spinal canal compromise from 65% preoperatively to 11% following surgery.