颈椎棘突骨折与颈椎稳定性

目的探讨不同类型颈椎棘突骨折与颈椎稳定性的关系。方法回顾性研究14例(15个)单纯颈椎棘突骨折,分为无椎板累及和椎板累及两组,分析受伤机制、病理特点、影像表现和治疗方法;使用AdobePhotoshop软件测量两组侧位X线片骨折线与水平线夹角,SPSS11·0作均数t检验。结果无椎板累及者9例,椎板累及者5例,两组骨折线与水平线夹角分别为57·32°±7·27°和24·36°±6·91°,t=8·260(P<0·05),差异有统计学意义。5例均证实有颈椎不稳,4例行前路手术。结论累及棘突椎板线的颈椎棘突骨折存在颈椎不稳,治疗方法不同于常见的铲土者骨折,需常规摄颈椎过伸过屈侧位X线片,以便早期作出诊断与正确的处理。     

前路减压植骨钢板系统内固定治疗颈椎病30例

目的探讨颈前路减压植骨内固定术治疗颈椎病的方法与效果。方法2002-2007年共收治30例颈椎病患者,采用颈前路减压、自体髂骨植骨或者钛网植入、钛板内固定术治疗。结果随访30例．平均随访时间1年。按JOA评分评价手术疗效,术前评分平均10分．术后评分为13分,优良率为81．2％。结论前路手术治疗颈椎病疗效可靠。减压彻底,安全性高。     

Cervical exenteration

Cervical exenteration is a radical operation to remove the larynx, portion of the trachea, and the esophagus, and frequently requires a mediastinal tracheostomy. Highly selected patients with obstructing neoplasms of the esophagus and airway can be palliated and sometimes cured by this aggressive surgical approach. Fatal hemorrhage from pressure or exposure of the innominate artery is avoided by elective division of the artery (preoperative angiograms and intraoperative electroencephalographic control are essential), using the omentum to separate the trachea and great vessels, and removal of a bony plaque of chest wall to allow a well-vascularized bipedicled skin flap to drop into the mediastinum for the tracheocutaneous anastomosis. Eighteen exenterations were performed. Mediastinal tracheostomy was performed in 14 patients and division of the innominate artery was performed in 7. Esophageal replacement was predominantly with the left colon. Complications include esophageal leak (2 patients), stomal separation (2), transient hemiplegia (1), colonic obstruction by substernal tunnel (1), and need for prolonged mechanical ventilation (4). There was a single operative death. Postoperative survival was disease dependent. All patients achieved an excellent airway and relief from dysphagia.     

Cervical myelopathy

Summary This report covers a series of 76 patients with cervical myelopathy, of whom 16 had a posterior decompression by laminectomy and 60 had an anterior fusion operation in which we used the operating microscope.Starting from the clinical history we have made a subdivision of the spinal and mixed radiculo-spinal syndromes, into acute, subacute and chronic types. The grouping on the basis of the varying length of history (4 months, one year, longer than one year) is purely arbitrary, derived from the distribution of our material (see Fig. 2). In theacute syndrome group, an acute episode in the history occurs in 46% and an extruded disc sequestrum in 63% of the cases. Spondylotic deformities were less frequently seen (25%). In thechronic syndrome group perforations of disc material are much less frequent (21%), marked osteochondrosis, however, more frequent (65%). Our results from the 16 laminectomies in this series were as disappointing as were the results of an earlier series carried out in our clinic by Tönnis and Krenkel (34). By the anterior approach an improvement in the symptoms could be achieved in 38 out of 60 cases (63%). Nearly half of these patients (47%) became completely fit for work at their old or a comparable job. But the other half showed severe disabilities in the form of unchanged or, in 15% of the cases, increased disturbances of gait and/or pareses of their arms. In four patients deterioration appeared several years after initial post-operative improvement without any signs of other space-occupying lesions, demonstrating the variety of etiological factors influencing the syndrome of myelopathy. Therefore a subdivision of the syndrome, as suggested above, and detailed analysis of the operative findings would appear to be useful in the assessment of the prognosis of myelopathy.In the chronic cases with osteochondrosis or disc protrusion there was an improvement in only 30% of the cases. However, better results were secured in patients with acute syndromes and extruded disc lesions: a substantial improvement could be achieved in 50% of the cases.We must exclude from this favourable prognosis of the acute cases those cases with a hyperacute onset and the development of symptoms within a few hours or minutes, as in the patient described above (p. 106). Nevertheless an immediate diagnosis and operation is indicated in all acute and subacute cases of cervical myelopathy.

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Zusammenfassung Es wird über 76 Patienten mit zervikaler Myelopathie berichtet. Bei 16 Patienten wurde eine dorsale Entlastung durch Laminektomie, bei 60 Patienten eine ventrale Fusionsoperation mit Hilfe des Operationsmikroskops vorgenommen.Ausgehend von der klinischen Vorgeschichte wurde eine Unterteilung dermedullären undgemischt radikulär-medullären Syndrome in eineakute, subakute undchronische Verlaufsform vorgenommen. Die Zuordnung auf Grund der unterschiedlich langen Anamnesedauer (4 Monate, 1 Jahr, länger als 1 Jahr) ist willkürlich, aber aus der quantitativen Verteilung unseres Krankengutes abgeleitet (Fig. 2), auf Grund des häufigen Auftretens eines akuten Ereignisses in der Anamnese (46%) und Vorliegen eines perforierten Bandscheibenvorfalls (63%) beiakuten Syndromen, während hier weniger spondylotische HWS-Veränderungen in Form dorsaler Osteophyten (25%) beobachtet wurden.Chronische Syndrome zeigten dagegen viel seltener Sequester-Perforationen (21%), jedoch häufiger erhebliche Osteochondrosen (65%).Die unbefriedigenden Ereignisse nach Laminektomie bestätigten die Ergebnisse einer früheren Zusammenfassung aus unserer Klinik durch Tönnis und Krenkel (34). Durch die ventrale Operationsmethode ließ sich jedoch in 38 von 60 Fällen (63%) eine Besserung der Symptomatik erreichen. Nahezu die Hälfte dieser Patienten (47%) wurde in ihrem alten oder einem gleichwertigen Beruf wieder voll arbeitsfähig. Zu beachten ist allerdings, daß die andere Hälfte der Patienten erheblich gehbehindert und dadurch arbeitsunfähig blieb, bzw. in 15% durch allmähliche Verschlechterung geworden ist; in 4 Fällen nach voübergehender post-operativer Besserung, ohne daß Anzeichen erneuter Raumforderung vorlagen. Dies wird als Folge einer, der Erkrankung immanenten multicausalen Genese gedeutet. Deshalb erscheint die oben angegebene Unterteilung des Syndroms und die Berücksichtigung des Operationsbefundes zur Beurteilung der Prognose der zervikalen Myelopathie nützlich:Bei chronischen Syndromen mit im Vordergrund stehenden degenerativen Veränderungen konnte lediglich eine Besserung in 30% der Fälle erreicht werden.Die besten Ergebnisse wurden bei akuten Verläufen und perforiertem Bandscheibenvorfall mit einer deutlichen Besserung in 50% der Fälle erzielt. Von der günstigen Prognose akuter Verläufe ausgenommen werden perakute Verlaufsformen mit Syndromausbildung in wenigen Stunden oder Minuten, wie in dem auf S. 106 geschilderten Fall.Jedoch ist die möglichst rasche Diagnostik und Operation in allen Fällen akuter und subakuter Verlaufsformen einer zervikalen Myelopathie indiziert.

     

Cervical esophagostomy

• TOTAL HIP ARTHROPLASTY PROCEDURES relieve patients' arthritic hip pain. Since the first procedure was performed in the 1960s, surgeons and implant companies have worked to improve prosthesis design, composition of implants, and the mechanisms for holding the implants in place.• RECENTLY, SURGEONS HAVE FOCUSED on minimizing the surgical incision. Smaller incisions have resulted in smaller scars and faster recoveries.• THIS ARTICLE PRESENTS a brief historical overview of, as well as current trends in, minimally invasive total hip arthroplasty. All aspects of care for a patient undergoing total hip arthroplasty are discussed. AORNJ 79 (June 2004) 1244–1258.

Cervical Vertigo

This paper describes the clinical, audiological, routine vestibular and X-ray findings in 80 patients with cervical vertigo. Together with these are the electronystagmographic abnormalities recorded with head and neck movement before and after manipulation of the cervical and upper dorsal spine (without anesthesia), and the symptomatic response to this treatment.