神经根型颈椎病的微创治疗

目的探讨经后路微创手术治疗神经根型颈椎病的疗效。方法采用后方小切口入路对32例神经根型颈椎病患者实行经后路微刨手术治疗,并对手术效果进行了临床随访观察。结果对14例年轻患者黄韧带增厚不明显、椎间盘质地较软者,在椎间孔扩大的同时行突出椎问盘切除,其余18例老年患者则因局部黄韧带明显增厚并有骨化,椎间盘质地较韧,切除困难,故只行椎间孔扩大,神经根减压;术后所有患者神经根痛症状均有改善,对28例患者进行了3～16个月的随访,术后没有出现颈部活动障碍和临床症状的复发。结论采用微刨手术治疗神经根型颈椎病,创伤小、安全、简捷、有效,一次手术即可切除绝大部分突出的椎间盘,在不影响颈椎稳定性的同时又完成了神经根减压     

Postoperative instability after laminoplasty for cervical myelopathy with spondylolisthesis

OBJECTIVE: 76 patients who underwent laminoplasty for cervical spondylotic myelopathy were investigated regarding the impact of preoperative and postoperative degenerative spondylolisthesis on their neurologic outcome. METHODS: Radiographs were obtained 1 year postoperatively to investigate range of motion (ROM), lordotic curvature, and postoperative spondylolisthesis. RESULTS: By 1 year after surgery, 85% of those spondylolistheses present preoperatively had either resolved or improved on neutral lateral radiographs. The cross-sectional area of the spinal cord at the site of spondylolisthesis was measured using preoperative computed tomography myelography. Clinical results were evaluated by the recovery rate using Japanese Orthopaedic Association score. Patients with posterior spondylolisthesis showed a significantly poorer postoperative recovery rate. Intervertebral ROM in patients with preoperative spondylolisthesis was reduced, whereas cervical alignment had not deteriorated after laminoplasty. The group with posterior spondylolisthesis showed a significant reduction in the cross-sectional area of the spinal cord at the site of spondylolisthesis. Postoperative spondylolisthesis appeared in 15 patients, 10 of whom had preoperative spondylolisthesis at an adjacent site. CONCLUSION: The cause of poorer surgical results of those patients with preoperative posterior spondylolisthesis appears to be related to a higher degree of spinal cord compression than with preoperative anterior spondylolisthesis.     

后路单开门联合椎间孔切开术与前路减压融合术治疗混合型颈椎病的疗效比较

 目的 通过回顾性病例分析,评价单开门椎板成形联合椎间孔切开术(laminoplasty with foraminotomy, LF )与前路椎间盘切除减压融合术（anterior cervical discectomy and fusion,ACDF）治疗脊髓神经根型颈椎病的临床及影像学疗效。方法 自 2008 年 1 月至 2010 年 1 月,按照纳入及排除标准选取 68 例患者纳入研究,ACDF 组 33 例,LF 组 35 例,随访均超过 2 年。疗效评估采用日本骨科协会（Japanese Orthopedic Association,JOA）评分及改善率,影像学评估采用 X 线片测量颈椎曲度和颈椎活动度（range of motion, ROM）,末次随访时采用颈椎功能障碍指数量表（neck disabilitv index,NDI）评估两组患者颈肩部疼痛的改善程度。结果 ACDF 组手术时间平均 187 min、出血量平均为 127 ml,与 LF 组（154 min、235 ml）比较,差异均有统计学意义（t _手术时间=4.170,P=0.000;Z _出血量=-6.888,P=0.000）。术后两组下肢感觉改善率（ACDF 组 64.0%、 LF 组 66.0%）的差异有统计学意义（Z=-7.512,P=0.000）,而上肢运动、上肢感觉及下肢运动改善率的差异均无统计学意义。术后 3 个月时 ACDF 组出现 1 例植骨不融合,随访 2 年时 3 例出现邻近节段退变;而 LF 组未见并发症出现。末次随访时 ACDF 组在提物（Z=-3.947, P=0.000）及开车（t=-7.523,P=0.000）方面的 NDI 疼痛评分低于 LF 组。ACDF 组颈椎曲度由术前平均 13.7°增加至 16.2°,而 LF 组由 14.6°降至 13.3°（Z=-3.374,P=0.001）。两种术式均导致术后颈椎 ROM 下降（ACDF 组 14.8°、LF 组 16.5°）,但差异有统计学意义（t=-2.167,P =0.034）。结论 LF 在改善长节段颈椎间盘突出所致的颈椎髓性症状及根性症状方面与 ACDF 的临床效果相近,但具有手术时间短、手术技术相对简单、近期并发症发生率低等优势,是治疗混合型颈椎病安全、有效的手术方式。     

Treatment of cervical OPLL by cervical anterior fusion using autologous vertebral bone grafts

Background  

In anterior fusion, we use autologous bone grafts from cervical vertebral bodies and bioabsorptive screws to prevent graft extrusion (Williams-Isu method). We report the application of and indication for the Williams-Isu method for OPLL and present our clinical and radiological results.     

颈后路锚钉法单开门结合侧块螺钉内固定治疗颈椎后纵韧带骨化症合并节段性失稳

[目的]探讨颈后路锚钉法单开门椎管成形结合侧块螺钉内固定治疗颈椎后纵韧带骨化症合并节段性失稳的临床疗效。[方法]本组31例患者,均诊断为颈椎后纵韧带骨化症合并颈椎节段失稳,其中连续型后纵韧带骨化5例,间断型后纵韧带骨化6例,混合型后纵韧带骨化20例;31例均为单节段失稳,其中C3、4失稳7例、C4、5失稳15例、C5、6失稳8例,C6、7失稳1例。所有患者均行颈后路锚钉法单开门椎管成形结合选择性侧块螺钉内固定治疗。术前和术后3个月、末次随访时分别对患者视觉疼痛模拟评分(VAS)和JOA评分进行统计学分析。[结果]手术时间120²10 min,平均162 min;术中出血420210 min,平均162 min;术中出血420¹ 300 ml,平均730 ml;28例患者术后症状明显改善,1例术后出现双侧C5神经根麻痹,2例单侧C5神经根麻痹,经脱水、神经营养、高压氧等对症治疗好转后出院。全部病例随访121 300 ml,平均730 ml;28例患者术后症状明显改善,1例术后出现双侧C5神经根麻痹,2例单侧C5神经根麻痹,经脱水、神经营养、高压氧等对症治疗好转后出院。全部病例随访12⁶0个月,平均30.3个月。31例患者术后3个月、末次随访时VAS评分和JOA评分与术前比较均有显著性差异(P<0.05)。[结论]颈椎后路锚钉法单开门椎管成形结合侧块螺钉内固定治疗颈椎后纵韧带骨化症合并节段性失稳患者早期疗效满意,其远期疗效尚有待进一步随访总结。     

Electrophysiologic diagnosis of cervical OPLL myelopathy using evoked spinal cord potentials

The purpose of this study is to establish the correct diagnosis of the location and extent of intraspinal cord lesions in cases of continuous or mixed-type ossification of the posterior longitudinal ligament and to estimate the postoperative prognosis using evoked spinal cord potentials (ESCP). Twenty-six patients, who underwent surgery from 1985 to 1987 and who have been followed for more than 6 months, were examined using a conductive ESCP, which demonstrates lower extremity, bowel, and bladder function, and a segmental ESCP and dermatome segmental ESCP, which demonstrate upper extremity function. A five-pole recording electrode was placed in the cervical epidural space. The stimulation sites were the thoracic epidural space for conductive ESCP, the median nerve at the elbow for the segmental ESCP, and the finger surface for the dermatome segmental ESCP. In cases in which the ESCP disappeared at the middle of the narrow cervical spinal canal, another stimulating electrode was placed in the cisterna magna, and a descending conductive ESCP was recorded to monitor the upper border of the spinal lesion. New findings, which could not be observed by roentgenograms, myelography, and CT scan, were detectable using this technique.     

脊髓造影加CT与MRI对颈椎病及后纵韧带骨化诊断价值的比较

本文通过对３８例脊髓型颈椎病术前脊髓造影加ＣＴ和ＭＲＩ结果的比较分析，就此二种检查方法的诊断价值做出了评价。结果提示在显示颈椎间盘突出方面，ＭＲＩ明显优于脊髓造影加ＣＴ；在显示颈椎骨质增生、ＯＰＬＬ、颈神经很受压方面，ＭＲＩ不如脊髓造影加ＣＴ；在显示颈椎管狭窄蛛网膜下腔和脊髓受压方面，ＭＲＩ和脊髓造影加ＣＴ无明显差异。     

Genetic study on OPLL in the cervical spine with HLA haplotype

HLA typing was carried out in 27 families with cases of ossification of the posterior longitudinal ligament (OPLL) in the cervical spine, with haplotype analysis for genetic factors. The results showed a significantly higher incidence of rare haplotypes in probands than in the general Japanese population, suggesting that certain genes linked to HLA are responsible for OPLL. On examination of the distribution of HLA haplotypes in families with members suffering from cervical OPLL, no evidence of OPLL was found in members with only one haplotype in common with the proband. In 9 of 15 siblings with two haplotypes in common, however, OPLL was observed. Further analysis of HLA haplotyping may contribute to the elucidation of the genetic determinants of OPLL linked to two HLA haplotypes, probably based on multifactorial inheritance.     

颈椎椎间盘退行性改变与颈椎不稳

探讨颈椎椎间盘退性改变与颈椎不稳定的关系。方法对２６０例怀疑有颈椎疾患的者行Ｘ线及ＭＲＩ检查。在颈椎屈曲／伸展侧位片上测量椎体水平位及成象程度,并根据ＭＲＩＴ２加权像椎间盘信号强度判断其退变程度。结论颈椎的节段性不稳定是颈椎椎间盘退行改变的早期表现之一。     

炎性细胞在腹主动脉瘤形成中的作用

目的研究炎性细胞在腹主动脉瘤（ａｂｄｏｍｉｎａｌａｏｒｔｉｃａｎｅｕｒｙｓｍ,ＡＡＡ）组织中的浸润情况及其作用。方法２０例ＡＡＡ患者的动脉瘤组织及４例正常人腹主动脉组织,分别行弹力纤维和胶原纤维的特殊染色、单抗白细胞共同抗原（ＣＤ４５阳性）和巨噬细胞（ＣＤ６８阳性）的免疫组化染色,了解纤维组织的变化及炎性细胞的浸润程度;原位杂交方法观察ＡＡＡ组织中基质金属蛋白酶（ｍａｔｒｉｘｍｅｔａｌｏｐｒｏｔｅｉｎａｓｅｓ,ＭＭＰｓ）之ＭＭＰ９的ｍＲＮＡ表达。结果ＡＡＡ组织均有不同程度的炎性细胞浸润,炎性细胞浸润程度与基质弹力纤维的损伤程度呈平行趋势,正常腹主动脉组织无炎性细胞浸润;原位杂交结果显示２０例ＡＡＡ组织中的巨噬细胞和淋巴细胞均出现ＭＭＰ９ｍＲＮＡ的阳性表达,１３例（６５％）ＡＡＡ组织中的平滑肌细胞出现ＭＭＰ９ｍＲＮＡ的阳性表达。正常腹主动脉组织无ＭＭＰ９ｍＲＮＡ的阳性表达。结论炎性细胞在ＡＡＡ形成中通过复杂的生化、细胞及免疫等过程参与并促进了ＡＡＡ的形成。     

HLA-DQA1等位基因与颈椎后纵韧带骨化的相关性研究

目的 :分析颈椎后纵韧带骨化 (COPLL)患者与人类白细胞抗原DQA1 (HLA DQA1 )等位基因的相关性。方法 :用聚合酶链式反应 序列特异引物 (PCR SSP)法对COPLL患者 (2 7例 )及对照组 (51例 )进行HLA DQA1等位基因的基因分型。结果 :HLA DQA1 0 4 0 1同COPLL呈显著正相关 (P <0 0 1 ) ,DQA1 0 2 0 1与COPLL呈显著性负相关 (P <0 0 1 )。结论 :HLA DQA1 0 4 0 1可能与COPLL的疾病易感性相关 ,HLA DQA1 0 2 0 1可能与COPLL的抗性相关 ,在HLA DQA1位点存在易感和抵抗双重作用 ,等位基因之间的共同作用可能是影响COPLL发病的重要因素之一。     

Results of surgical treatment of radiculomyelopathy caused by cervical arthrosis based on 1000 operations

Wide experience over a 20-year period with 1000 interventions for radiculomyelopathy caused by cervical arthrosis is reported. The results are analyzed according to clinical signs, surgical methods, timing of operation, influence of pathogenic phenomena, age, and preexisting illness. Intra- and postoperative problems and accidents are covered.     

Subacute cervical spine instability

A case of delayed onset of C5-6 subluxation after a motor vehicle accident, with normal initial cervical spine roentgenograms and neurological findings consistent with concomitant cerebral trauma, is presented. Damage to the cervical spine was due to fractures of the C-6 body and superior articular facet undetected by routine radiologic studies.     

Pediatric cervical spine instability

Cervical spine instability in children is rare but not exceptional and may be due to many factors. Although it mostly occurs at the upper cervical spine, all vertebrae from the occiput to T1 may be involved. It may be acute or chronic, occurring secondary to trauma or due to congenital anomaly, skeletal or metabolic dystrophy or rheumatoid arthritis. It can be isolated or associated with other musculoskeletal or visceral anomalies. A thorough knowledge of embryology, anatomy, physiology and physiopathology of the cervical spine in children is essential to avoid pitfalls, recognize normal variants and identify children at risk of developing cervical spine instability and undertake the appropriate treatment.     

Delayed post-traumatic cervical instability

BACKGROUND

Cervical spine instability is a clinical entity whose biomechanical and radiological features have been widely discussed by many authors. On the other hand, the subject of delayed post-traumatic cervical instability is often surrounded by confusion due to its difficult nosologic framing; the aim of this study is to contribute to the matter.

METHODS

A cooperative study was organized by the Study Group for Spinal Surgery of the Italian Society of Neurosurgery to evaluate cervical trauma patients surgically treated more than 20 days after the traumatic event. From a total number of 172 patients, twenty-five were admitted to the study, because neuroradiological investigations performed during the acute phase had shown either an absence of traumatic lesions or only minimal lesions judged to be stable. For this reason these 25 patients had not been treated by either surgery or immobilization in a halo vest. Some time after trauma, this group of patients clearly demonstrated evidence of unstable lesions requiring surgical treatment, following the appearance of new clinical signs or on neuroradiological follow-up.

RESULTS

Re-examination of the neuroradiological investigations performed during the acute phase made it possible to identify elements that might have led us to suspect the presence of ligamental lesions: microfractures, dislocations less than 3 mm, and inversion of physiological lordosis.

CONCLUSIONS

This review clearly indicates that patients with even mild cervical trauma must be scrupulously evaluated during the acute phase and that in some cases it is advisable to perform a more detailed neuroradiological investigation.     

The results of surgical treatment of spondylotic radiculomyelopathy with complete cervical laminectomy and posterior foramen magnum decompression

Summary Twenty-six patients with cervical spondylosis and radiculomyelopathy were treated surgically. Eight patients had cervical laminectomy C₁-C₇, and 16 patients had complete cervical laminectomy C₁-C₇ with excision of the posterior rim of the foramen magnum. Follow-up of patients was from two months to eight years.The majority of patients improved markedly, and some of them had excellent results.