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统计我院自 1997年以来由成人颈椎先天性融合畸形所致颈椎病的资料 4例 ,现报告如下。临床资料一、一般资料 本组男 3例 ,女 1例 ,年龄 3 1~ 5 5岁 ,其中颈 2~ 3融合 1例 ,颈 5~ 6融合 2例 ,颈 3~ 4融合 1例。X片证实均为双椎体融合 ,伴脊柱侧弯者 2例 ,先天性高肩胛症者1例。临床表现均有不同程度颈肩痛 ,上肢放射痛 ,持物不稳等症状 ,其中四肢痉挛瘫 ,步态不稳 ,Hoffmann′ssign(+ ) 2例。术前均行MRI检查示 :融合部位下位颈椎退变 ,椎间盘突出压迫脊髓者 1例 ,上下两个节段均有退变压迫脊髓者 3例。二、手术方法 … 相似文献
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先天性颈椎融合伴颈椎间盘突出症12例报告 总被引:1,自引:0,他引:1
本文报告12例先天性颈椎融合伴颈椎间盘突出症,探讨了其发生机理,诊断和治疗方法。指出此种类型颈椎间盘突出与先天性颈椎融合有密切关系。当存在先天性颈椎融合时,未融合的节段活动增加,使椎间盘较早和较容易发生退行性改变而引起颈椎间盘突出症。MRI对其明确诊断具有重要价值。本病以采用手术疗法为主,其中以颈前路减压术为首选。 相似文献
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先天性颈椎融合与外伤性瘫痪蒋会平,刘家明,关继华,王泽强我们自1988年2月份至今,共观察17例先天性颈椎融合病人,发现先天性颈椎融合患者对颈部外伤耐受性明显低于正常人。前者在轻度颈部外伤就可能引起瘫痪,与郭世级报道相符合[1]。而后者即使有严重外伤... 相似文献
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先天性小耳畸形病因学研究进展 总被引:3,自引:0,他引:3
先天性小耳畸形是一种先天性的耳发育畸形,主要表现为耳郭的大小、形态及耳郭表面标志结构等发生不同程度的变化甚至耳郭缺如,并常伴有外耳道的狭窄或闭锁,可伴听力障碍,主要影响患者的外观。研究者们一直在努力通过各种方法和手段探寻小耳畸形的病因,笔者就先天性小耳畸形病因学方面的研究情况综述如下。 相似文献
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真两性畸形病因学研究进展 总被引:3,自引:0,他引:3
真两性畸仍遗传异质性,随着人们对性别决定机制的了解,对本病的发病机制也有了一定认识。本文拟对近年来真两性畸形的分子病因学研究做一综述。 相似文献
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[目的]分析先天性上颈椎畸形造成上颈椎不稳的病因,探讨其手术方法的选择.[方法]2003年1月~2007年6月收治65例先天性上颈椎畸形,男39例,女26例,术前常规进行X线片、CT和MRI检查,根据影像学分为发育不全畸形32例,分节不全畸形18例,结构畸形15例.37例可以复位并且脊髓前方无明显受压患者采用后路固定、植骨融合,其他28例上颈椎脱位不可复位或者脊髓前方存在压迫患者,首先采用前方齿状突切除、减压,然后经后路内固定、取自体松质骨植骨融合.[结果]所有患者均顺利完成手术,未出现脊髓血管损伤等严重并发症.65例患者中47例获得随访,随访12~24个月,平均随访(15±6)个月.1例患者后路钛棒断裂,再次手术更换断裂钛棒,其余患者后方植骨形成骨性融合.34例上颈椎局部疼痛、活动受限患者中28例获得随访,患者疼痛均明显减轻或者消失.31例四肢麻木、上运动神经元损伤患者中19例患者获得随访,采用Frankel脊髓评分,术前患者评分5例B,8例C,17例D;获得随访患者术后Frankel评分5例C,6例D,8例E,与术前相比神经功能改善1~2级.[结论]根据先天性上颈椎畸形的病因、环枢椎复位和脊髓受压情况,分别选择后路或者前后路联合手术治疗. 相似文献
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真两性畸形具有跗异质性,随着人们对性别决定机制的了解,对本病的发病机制也有了一定认识。本文拟对近年来真两性畸形的分子病因学研究做一综述。 相似文献
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先天性颈椎复合畸形并继发性颈髓压迫症1例报告邱永荣患者刘××,女,45岁,农民,“进行性双下肢活动困难1+年,右上肢无力5+月”四肢沉重僵硬感,于93年3月9日入院,住院号263688。上述症状进行性加剧,并尿潴留。既往无慢性枕颈肩臂痛史及外伤史。可... 相似文献
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目的 :分析先天性颈胸段脊柱畸形经后路截骨矫形术后颈椎序列变化及其影响因素。方法:回顾性分析2012年3月~2017年3月于我院行后路截骨矫形术治疗的26例先天性颈胸段脊柱畸形患者的临床及影像学资料,男10例,女16例,年龄14.2±4.6岁(9~20岁),随访时间38.0±6.4个月(24~96个月)。畸形节段位于C6~T5,其中半椎体5例,楔形椎2例,蝴蝶椎3例,半椎体合并蝴蝶椎4例,半椎体合并骨桥7例,阻滞椎5例。融合节段7.7±3.2个(3~13个)。收集患者术前、术后2周及末次随访时站立全脊柱正侧位X线片,测量冠状面影像学参数,包括原发及远端代偿弯Cobb角、冠状面T1倾斜角(T1 tilt)、锁骨角(clavicle angle,CA)、颈部倾斜(neck tilt,NT)、头部偏斜(head shift,HS)及冠状面平衡距离(coronal balance distance,CBD);测量矢状面影像学参数,包括颈椎矢状垂直轴(C2-C7 sagittal vertical axis,C2-C7 SVA)、颈椎前凸角(cervical lordosis,CL)、颈胸后凸角(cervicothoracic kyphosis,CTK)、矢状面上端椎(upper end vertebrae,UEV)/T1倾斜角、胸椎后凸角(thoracic kyphosis,TK)、胸段后凸角(UEV/T1-T12)、腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、矢状垂直轴(sagittal vertical axis,SVA)偏距。根据术前颈椎序列将患者分为前凸组(CL-5°)及僵直/后凸组(CL≥-5°),前凸组8例,僵直/后凸组18例。根据术后至末次随访期间颈椎僵直/后凸是否发生进展(△CL5°为进展)将术前僵直/后凸组患者分为后凸进展亚组(7例)与后凸无进展亚组(11例)。比较组间影像学参数差异,通过Pearson相关系数分析术前、术后及末次随访时可能影响颈椎曲度变化的影像学参数,评估SRS-22量表评分。应用Pearson卡方检验、Fisher精确检验、配对及独立t检验及Pearson相关系数分析比较组间影像学参数及SRS-22量表评分差异。结果 :26例患者原发弯平均矫正率67.0%,远端代偿弯平均矫正率47.9%,HS、NT、CBD、T1 tilt、CA末次随访时均较术前明显改善(P0.05)。颈椎前凸组术前、术后、末次随访时矢状面参数无统计学差异(P0.05)。颈椎前凸组术前UEV/T1倾斜角及术前UEV/T1-T12较颈椎僵直/后凸组有统计学差异(分别为20.2°±0.5°vs 16.4°±4.3°,49.3°±5.2°vs 36.3°±14.3°,均P0.05)。颈椎僵直/后凸组术前4例伴颈椎矢状面失平衡(C2-C7 SVA≥4cm),颈椎后凸进展组与无进展组比较,术前矢状面参数均无明显差异;术后CTK(2.4°±3.9°vs 12.7°±4.3°,P0.05)、UEV/T1-T12(18.7°±3.6°vs37.8°±7.6°,P0.05)有统计学差异,其余无统计学差异;末次随访时,CTK(5.2°±4.9°vs 11.7°±6.5°,P0.05)、UEV/T1-T12(20.4°±7.5°vs 38.5°±9.4°,P0.05)、LL(-46.4°±7.9°vs-36.4°±5.2°,P0.05)、SVA(-5.3cm±1.2cm vs-2.8cm±2.0cm,P0.05)有统计学差异,其余无统计学差异(P0.05)。术前颈椎后凸与术前UEV/T1-T12呈负相关(r=-0.398,P=0.045),术后颈椎后凸与术后CTK呈正相关(r=0.673,P0.001),末次随访颈椎后凸进展与术后-末次随访△LL(r=0.557,P=0.020)及△SVA呈正相关(r=0.496,P=0.034)。SRS-22量表评估术前颈椎僵直/后凸组自我形象及心理健康维度评分低于颈椎前凸组(P0.05),末次随访时颈椎后凸进展组疼痛评分低于颈椎前凸组及颈椎后凸无进展组(P0.05),颈椎前凸组、颈椎后凸无进展组总评分均优于颈椎后凸进展组(P0.05)。结论:先天性颈胸段脊柱畸形患者颈椎后凸发生率较高,术前颈椎后凸可能与UEV/T1-T12过小有关。一期后路截骨矫形术后,CTK过小、术后LL增大及SVA后移可导致远期颈椎后凸进展。 相似文献
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《中国整形与重建外科(英文)》2021,3(4):181-188
BackgroundCongenital thumb deformities account for one-third or more of all cases of congenital hand deformity. However, the current classification schemes of congenital thumb hypoplasia are no longer adequate due to their lack of adaptability to increasing knowledge in the field. Hence, a modified system with the potential to adapt to ongoing advances in knowledge and understanding is desperately needed.MethodsBased on the photographs collected from thousands of cases of congenital deformities of the hand and upper limb over multiple decades in our department, we subdivided thumb hypoplasia according to the variables of morphological characteristics, anatomical structures, functional status, the relationship between thumb deformity and hand deformity, the relationship between congenital hand deformity syndrome and thumb hypoplasia, and the selection of treatment methods.ResultsA total of 10 types were presented, which were elucidated with nomenclatures as well as pathological feature and symptoms.ConclusionThis modified system may shed additional light on the classification of congenital thumb anomalies, which will assist in a more effective selection of treatment modalities and offers significant benefits to both patients and practice. 相似文献
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目的:通过对颅底凹陷症患者的影像学观察和测量,探讨寰枕融合和/或C2-3融合在颅底凹陷症发病机制中的意义。方法:选择我院自2009年3月~2011年12月治疗的50例伴有寰枢椎脱位的颅底凹陷症患者(观察组),行颅骨正侧位摄片及包含颅底部的颈椎CT扫描和三维重建,统计其中寰枕融合、C2-3融合、寰椎侧块楔形变、枢椎上关节面斜坡化的例数。并从医院数据库调用相同年龄性别分布的50例正常人的头颅影像数据作为对照。测量两组人群的枕骨斜坡角(α)、齿状突顶点到Chamberlain线的距离(a)、齿状突顶点到枕骨大孔的距离(b)、硬颚后缘投影点距离寰椎侧块下缘的距离(h)、颈脊髓脑干角(β)等参数。比较两组间的差异。结果:50例颅底凹陷症患者中40例(80%)合并寰枕融合(C0-1),28例(56%)合并C2-3融合(其中1例为C2-3-4)融合,20例同时合并C0-1、C2-3融合(40%),49例合并寰椎侧块楔形变。观察组α平均131°±11°,对照组平均135°±8°,两组间比较差异无显著性(P>0.05)。观察组a、b、h及β值分别为-8.6±3.7mm、-5.1±2.3mm、4.8±1.8mm及129°±15°,对照组分别为6.9±2.9mm、9.6±3.7mm、17.7±2.3mm及156°±17°,两组间比较差异均有显著性(P<0.05)。结论:先天性寰枕融合可以导致枢椎齿状突高位,这可能是形成颅底凹陷症的解剖基础;寰椎侧块楔形变及枢椎上关节面斜坡化可造成的寰枢关节结构性不稳;C0-1和/或C2-3融合导致C1/2之间的应力集中和寰枢关节的运动负荷增加,这可能是引发寰枢椎脱位的另一重要解剖因素。 相似文献
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Syncage在颈椎融合术中的应用 总被引:2,自引:0,他引:2
目的:探讨颈椎前路融合器Syncage在颈椎前路融合术中的应用效果。方法:2001年1月~2002年10月,对23例脊髓型颈椎病、11例颈椎间盘突出症和1例神经根型颈椎病患者行颈椎前路融合手术,小切口入路(3~4cm),椎间盘及部分椎体后缘切除后,保留椎体终板,椎间隙置入带自体松质骨的盘状或楔状Syncage。以手术前后X线片及JOA评分分析疗效。结果:35例随访7~17个月,平均12.1个月,置入的Syncage无移位、脱出,病变椎间隙恢复正常,术后半年时已有骨性融合。术前JOA评分平均10.30分,术后14.76分,二者有显著性差异(P<0.01)。结论:应用Syncage的颈椎前路融合术手术创伤小,病人术后恢复快,能早期活动,椎间融合牢固,短期疗效优良。 相似文献
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The implantation of a spacer is common practice after ventral discectomy in the cervical spine. Besides bone or bone cement (Palacos, Sulfix, and Allofix), the surgeon has the choice of a variety of factory-made implants (cages). We report on our experience with the Intromed ZWE [Zwischenwirbel-Ersatzsystem (Intervertebral Replacement System)] implant. The ZWE implant (Intromed Medizintechnik GmbH, 15754, Senzig, Germany), made from titanium 6AL 4V, consists of a flat quadrangular body with a large supporting surface on the bottom and top and a central hole. We report the first 100 cases treated with their 1- or 2-year follow-up completed (mean follow-up, 1.7 years). The mean age was 47±9 years (range: 27–73 years). The implantation was performed without filling the central hole. In addition to the clinical investigation of neurological alterations and the range of movement, X-rays were taken, and the clinical result was determined by an independent investigator according to the Odom Scale. After the minimum follow-up of 1 year, 32 patients scored excellent on the Odom scale, 38 patients good, 25 patients satisfactory, and 5 patients bad. In 74 cases, fusion occurred radiologically as bony bridging around the implant. In 21 cases, the cage showed no change and no radiolucency. In five cases, radiolucency around the implant occurred without instability at flexion-extension X-ray views. In CT scans done in two patients with complaints, we confirmed bony bridging inside the centre hole implanted empty. The Intromed-ZWE-System performs well in routine clinical use. Compared to bone or bone cement, the operating time is reduced. The Intromed System offers an easy fusion method for a competitive price. 相似文献
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保留终板的颈椎融合器在颈椎前路手术中的应用 总被引:2,自引:1,他引:1
目的:探讨保留终板的颈椎融合器在颈椎前路手术中的应用价值。方法:对试验组22例颈椎病患者进行颈椎前路减压和保留颈椎终板融合器植入术。对照组26例颈椎病患者进行颈椎前路减压和单纯自体髂骨移植。术后随访X线,观察椎间隙高度的变化,比较神经功能恢复情况。结果:术后随访12~24个月,平均16个月,3个月后的X线检查,试验组手术节段椎间隙高度增加(1.1±0.9)mm,而对照组降低(1.0±0.8)mm(P<0.05),试验组和对照组所有患者X线全获骨性融合;术后神经功能均有明显改善。结论:保留终板的椎间融合器能够有效的恢复椎间隙高度,促进颈椎融合。 相似文献
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Peter G. Passias Dennis Vasquez-Montes Gregory W. Poorman Themistocles Protopsaltis Samantha R. Horn Cole A. Bortz Frank Segreto Bassel Diebo Chris Ames Justin Smith Virginie LaFage Renaud LaFage Eric Klineberg Chris Shaffrey Shay Bess Frank Schwab 《The spine journal》2018,18(12):2187-2194
Background Context
Distal junctional kyphosis (DJK) is a primary concern of surgeons correcting cervical deformity. Identifying patients and procedures at higher risk of developing this condition is paramount in improving patient selection and care.Purpose
The present study aimed to develop a risk index for DJK development in the first year after surgery.Study Design/Setting
This is a retrospective review of a prospective multicenter cervical deformity database.Patient Sample
Patients over the age of 18 meeting one of the following deformities were included in the study: cervical kyphosis (C2–7 Cobb angle>10°), cervical scoliosis (coronal Cobb angle>10°), positive cervical sagittal imbalance (C2–C7 sagittal vertical axis (SVA)>4?cm or T1-C6>10°), or horizontal gaze impairment (chin-brow vertical angle>25°).Outcome Measures
Development of DJK at any time before 1 year.Methods
Distal junctional kyphosis was defined by both clinical diagnosis (by enrolling surgeon) and post hoc identification of development of an angle<?10° from the end of fusion construct to the second distal vertebra, as well as a change in this angle by <?10° from baseline. Conditional Inference Decision Trees were used to identify factors predictive of DJK incidence and the cut-off points at which they have an effect. A conditional Variable-Importance table was constructed based on a non-replacement sampling set of 2,000 Conditional Inference Trees. Twelve influencing factors were found; binary logistic regression for each variable at significant cutoffs indicated their effect size.Results
Statistical analysis included 101 surgical patients (average age: 60.1 years, 58.3% female, body mass index: 30.2) undergoing long cervical deformity correction (mean levels fused: 7.1, osteotomy used: 49.5%, approach: 46.5% posterior, 17.8% anterior, 35.7% combined). In 2 years after surgery, 6% of patients were diagnosed with clinical DJK; however, 23.8% of patients met radiographic definition for DJK. Patients with neurologic symptoms were at risk of DJK (odds ratio [OR]: 3.71, confidence interval [CI]: 0.11–0.63). However, no significant relationship was found between osteoporosis, age, and ambulatory status with DJK incidence. Baseline radiographic malalignments were the most numerous and strong predictors for DJK: (1) C2-T1 tilt>5.33 (OR: 6.94, CI: 2.99–16.14); (2) kyphosis<?50.6° (OR: 5.89, CI: 0.07–0.43); (3) C2–C7 lordosis<?12° (OR: 5.7, CI: 0.08–0.41); (4) T1 slope minus cervical lordosis>36.4 (OR: 5.6, CI: 2.28–13.57); (5) C2-C7 SVA>56.3° (OR: 5.4, CI: 2.20–13.23); and (6) C4_Tilt>56.7 (OR: 5.0, CI: 1.90–13.1). Clinically, combined approaches (OR: 2.67, CI: 1.21–5.89) and usage of Smith-Petersen osteotomy (OR: 2.55, CI: 1.02–6.34) were the most important predictors of DJK.Conclusions
In a surgical cohort of patients with cervical deformity, we found a 23.8% incidence of DJK. Different procedures and patient malalignment predicted incidence of DJK up to 1 year. Preoperative T1 slope-cervical lordosis, cervical kyphosis, SVA, and cervical lordosis all strongly predicted DJK at specific cut-off points. Knowledge of these factors will potentially help direct future study and strategy aimed at minimizing this potentially dramatic occurrence. 相似文献19.
目的:评价应用异体骨螺纹融合器(ATFC)行颈椎前路融合的疗效,观察融合器的转归。方法:20例患者行单间隙前路颈椎间盘切除减压后置入ATFC,并与20例植入自体髂骨(AICA)者对照。根据影像学资料,观察不同时期ATFC在体内的变化,测量椎间高度及节段前凸角改变,判断融合情况,并根据Odom标准评价临床疗效。结果:ATFC组与AICA组各有18例获随访,平均随访时间分别为3.5年与3.4。ATFC年组优良率77.8%,AICA组83.3%。ATFC组不融合率16.7%,AICA组11.1%,两组临床疗效及融合率比较差异无显著性。ATFC在术后2 ̄4个月破裂;年时大部分未被新生骨替代;年时部分被新生骨替代;年时仍未被完全替代。135ATFC组椎间高度平均丢失2.7mm,AICA组丢失1.4mm。ATFC组节段前凸角平均丢失4.5°AICA组丢失1.7°,。两组椎间高度及节段前凸角丢失比较差异有显著性意义(P<0.05)。结论:ATFC在体内的替代是一缓慢过程,其维持椎间高度及节段前凸能力较自体髂骨差。 相似文献
20.
Anterior interbody fusion using the cervical spine locking plate 总被引:1,自引:0,他引:1
Surgical Principles
The Cervical Spine Locking Plate system (CSLP) is designed to perform anterior fusions of the cervical and upper thoracic
spine. The screws are locked in the H shaped plate providing intrinsic angle stability. Early osseous integration is enhanced
by titanium plasma spray coating and by the hollow and perforated design of the screws. These features enhance the primary
and secondary stability of the fixation. Therefore the penetration of the posterior cortex of the vertebra with the screws
is not necessary, which is a decisive asset compared to conventional plate systems. This essentially diminishes the intraoperative
risks. The primary stability is superior to that of conventional plate systems as the screws are tightly locked into the plate
in convergence. 相似文献