GSS型椎弓根内固定系治疗胸腰椎爆裂性骨折合并脊髓损伤

目的探讨胸腰椎爆裂骨折合并脊髓损伤的手术治疗效果及GSS型椎弓根内固定系在胸腰椎爆裂骨折中的作用。方法对34例胸腰椎爆裂性骨折病人早期行后路切开复位GSS型椎弓根内固定，其中12例行半椎管切开减压，并对手术疗效进行评估。结果34例病人术后随访9～21个月，平均17个月，总优良率76．5％。影像学显示无断钉、无内固定松动现象发生。结论胸腰椎爆裂骨折合并骨髓损伤有效的治疗方法是早期切开复位内固定，GSS型椎弓根内固定系在治疗中有关键的治疗价值。     

强直性脊柱炎胸腰椎骨折的损伤特点和治疗

目的分析强直性脊柱炎胸腰椎骨折的损伤特点,探讨治疗方法。方法强直性脊柱炎胸腰椎骨折11例,保守治疗1例(L1压缩性骨折者);手术治疗10例,其中前路手术减压内固定3例,后路椎弓根螺钉系统复位内固定、植骨7例。结果切口无感染,无脑脊液漏。1例T12L1骨折行后路椎弓根螺钉系统复位内固定并植骨术(未行椎管探查或减压),麻醉苏醒后发现脊髓神经症状由术前的C级加重为B级;1例L3～5骨折伴马尾神经损伤行前路手术后第2天出现内固定松动、骨折椎再次移位,脊髓神经症状加重,再次行前路内固定取出和后路长节段椎弓根螺钉系统固定植骨术。患者均获得随访,时间10个月～5年,平均(32±4.8)个月,手术患者中8例植骨于6个月获得融合,2例不能明确是否融合。后期未出现内固定松动或断裂现象。脊髓神经损伤者除1例A级无改变、1例C级加重为B级(末次随访时为C级)、1例D级加重为A级外,其余3例有Ⅰ～Ⅱ级的恢复。9例无腰背痛,2例遗留轻度腰背部酸痛。结论强直性脊柱炎胸腰椎骨折患者宜行后路椎弓根螺钉固定、植骨治疗。     

急诊椎弓根内固定治疗Denis B型胸腰椎爆裂骨折

目的 探讨急诊椎弓根内固定治疗Denis B型胸腰椎爆裂骨折的疗效.方法 自2005年6月至2010年8月,采用急诊切开复位椎弓根内固定结合椎板切除减压、横突间植骨方法治疗Denis B型胸腰椎爆裂骨折患者30例.结果 30例胸腰椎爆裂骨折患者术后切口全部Ⅰ期愈合.随访时间36～18个月,平均27个月,结果显示27例为ASIA脊髓损伤分级E级(感觉运动功能正常),1例左下肢轻度麻木,肢体运动正常,2例右下肢麻木,肢体运动正常.未发生肢体功能障碍、椎间隙感染、内固定物断裂、脊髓神经二次损伤和截瘫等严重并发症.结论 采用急诊椎弓根内固定手术治疗Denis B型胸腰椎爆裂骨折,可在最短时间内使损伤椎体获得稳定,迅速解除胸腰椎骨折导致的脊髓或神经压迫,对预防并发症行之有效,有利于患者术后康复.     

后路减压椎弓根钉内固定治疗重度胸腰椎骨折伴脊髓损伤的疗效分析

目的探讨后路减压椎弓根钉内固定治疗重度胸腰椎爆裂骨折伴脊髓损伤的疗效。方法自2010-01—2014-06对30例重度胸腰椎爆裂骨折伴脊髓损伤采用后路减压椎弓根钉内固定治疗。结果本组手术时间65~120 min,平均95 min;术中出血量150~310 ml,平均210 ml。30例术后获得平均10.5(6~20)个月随访。末次随访时ASIA脊髓损伤分级:B级3例,C级5例,D级19例,E级3例;伤椎Cobb角9.2°~15.3°,平均11.4°;伤椎前缘高度压缩比10.2%~30.3%,平均21.4%。结论后路减压椎弓根钉内固定治疗重度胸腰椎爆裂骨折伴脊髓损伤可恢复并维持脊柱的力学稳定,可以有效解除骨折块对脊髓、神经的压迫,恢复椎管容积,促进脊髓神经功能的恢复。     

GSS内固定系统治疗胸腰段椎体爆裂性骨折43例分析

目的探讨GSS系统治疗胸腰段椎体爆裂性骨折的疗效。方法分析我院骨科从1999年5月～2008年1月应用GSS（General Spine System）椎弓根内固定系统治疗胸腰段椎体爆裂性骨折43例。根据神经功能判定（Frankel法）：B级2例；C级5例；D级29例；E级7例。结果病例随访平均14个月，末次随访时Franke分级：C级1例．D级12例，E级30例。临床疗效：术前胸椎平均后凸Cobb角优33例；良9例；可1例；差0例。角25．3度．术后后凸Cobb角3．4度，末次随访后凸Cobb角6．2度，平均丢失2．8度。结论GSS内固定系统可以三维矫形、三柱固定，具有操作简单，固定牢靠，创伤小，并发症少的特点。对胸腰段椎体爆裂性骨折，应用GSS椎弓根内固定系统进行手术治疗并植骨，就能取得满意的疗效。     

椎弓根螺钉系统加低温盐水灌注治疗胸腰椎爆裂骨折脊髓损伤

目的:探讨应用椎弓根螺钉系统加低温盐水灌注治疗胸腰椎爆裂骨折脊髓损伤的效果。方法:对16例爆裂骨折脊髓损伤患者,伤后6～30h行切开椎板减压复位、椎弓根螺钉系统固定;同时硬膜外用低温1～6℃盐水灌注受伤脊髓2～3h。结果:16例患者除3例神经功能A级脊髓神经症状无改善外,其余均有1～4级的恢复,改善率为81.2％;伤椎高度平均恢复到98％以上,伤椎椎管内无骨块。随访6个月～8年,平均2.8年,伤椎高度、脊柱生理弧度无丢失。结论:爆裂骨折脊髓损伤行椎弓根螺钉系统加低温盐水灌注治疗是较有效的方法,有利于脊髓神经功能恢复及康复,对维持伤椎高度及固定比较可靠。     

椎弓根内固定治疗胸腰段脊柱脊髓损伤

目的 综合评价椎弓根内固定治疗胸腰段脊髓损伤的效果。方法 分析31例应用椎弓根内固定胸腰段脊柱脊髓损伤者手术前后X线片,瘫痪恢复情况。结果 31例患者椎体前缘高度由术前51％恢复至95.8%,椎体后缘由术前74％恢复至96％。平均随访6.8个月,瘫痪恢复按ASIA分级,A级中2例无变化,余29例均提高1－2级。结论 椎弓根内固定是治疗胸腰椎骨折的有效方法,术中C－臂线机摄片是预防定位错误和螺钉位置不当的有效手段。     

后路减压加短节段椎弓根螺钉系统内固定治疗胸腰椎骨折并脊髓损伤

目的探讨脊柱后入路减压加短节段椎弓根螺钉系统内固定治疗胸腰椎骨折并不全瘫的效果。方法对27例胸腰椎骨折进行后路减压、植骨及Dick、RF内固定治疗。结果术后平均随访时间为11个月(6～20个月),脊柱后凸角度(Cobb’s角)由术前的24°平均恢复到10°(5°～15°);伤椎椎体前缘高度由术前35%(10%～60%)平均恢复到90%(80%～100%)。按Frankel脊髓神经功能分级标准D级19例,E级8例。结论后入路减压加短节段椎弓根螺钉系统内固定具有手术操作简单、损伤小、椎管减压充分等优点,有利于脊髓功能的恢复。     

GSS椎弓根螺钉内固定并二期伤椎骨水泥灌注治疗胸腰椎骨折

目的探讨GSS椎弓根螺钉内固定结合二期伤椎骨水泥灌注治疗胸腰椎骨折的有效性和安全性。方法2005年3月～2010年10月共31例胸腰椎爆裂性骨折患者行后路GSS椎弓根螺钉内固定治疗,术后3～18个月根据X线及CT复查情况,出现＂蛋壳现象＂的患者在取出内固定前行伤椎骨水泥灌注,记录术前、术后及末次随访时的伤椎高度及X线片测量的Cobb角角度。结果本组患者均未出现骨水泥渗漏,术后12～18个月取出内固定后再随访1～3年。术后伤椎椎体高度及Cobb角与术前相比有明显改善。结论 GSS椎弓根螺钉内固定结合二期伤椎骨水泥灌注治疗胸腰椎骨折可达到良好的治疗效果,可作为治疗胸腰椎骨折的新的尝试。     

经椎弓根内固定治疗胸腰椎骨折的失误和并发症分析

目的分析胸腰椎骨折经椎弓根内固定治疗的失误和术后并发症,并提出预防措施。方法1992～2002年采用经椎弓根内固定治疗175例胸腰椎骨折患者,男102例,女73例;平均43.1岁。其中RF系统内固定33例,AF系统内固定84例,中华长城系统内固定8例,DRFS系统内固定35例,Dick系统内固定4例,GSS系统内固定5例,Steffee钢板内固定6例。结果175例患者获1～6年随访。后路手术适应证选择错误8例,术中失误24例,骨折脱位复位差8例,内置物术后并发症32例,骨折术后后凸1例。结论椎弓根内固定系统是治疗胸腰椎骨折有效的固定方法之一,临床效果满意。术前认真制订手术计划,术中仔细操作、正确使用椎弓根内固定器可有效减少手术失误和术后并发症。     

跳跃性脊柱骨折并脊髓损伤的治疗

目的：探讨跳跃性脊柱骨折的诊断和治疗方法。方法 22例手术治疗12例,保守治疗10例,结果 漏诊率达22．7％,按Frankel功能分级,手术治疗和保守治疗脊髓功能均有恢复但差异不明显。结论 对该类损伤要明确受伤机制,仔细检查,以防漏诊。适当放宽手术指征,警惕其他脏器合并伤。     

Neuropathology with spinal instrumentation

Neurohistologic examination of the spinal cord and cauda equina were compared for 28 beagles undergoing anterior and posterior spinal destabilization procedures--Group I (n = 7), destabilized operative controls; Group II (n = 7), posterolateral bone grafting; Group III (n = 7), Harrington distraction instrumentation and posterolateral fusion; and Group IV (n = 7), Luque rectangular instrumentation and posterolateral fusion. All dogs had appeared neurologically intact upon repeated examinations prior to death. Neurohistological abnormalities (Wallerian degeneration of the dorsal columns, corticospinal tracts, and nerve roots, focal cystic degeneration, and intraspinal central cavitation) occurred in only 1 of the 14 animals (7%) in Groups I and II (noninstrumented) and in 9 of the 14 animals (64%) in Groups III and IV (instrumented). This result is statistically significant (p less than 0.001). Transient sensory disturbances and radicular paresthesias have been described in clinical reports of spinal instrumentation. It is probable that subclinical neurologic injuries, such as intraspinal and nerve root infarction in posterior neural tissue, can occur with the use of sublaminar hooks or wires. The chondrodystrophic beagle spinal model in this study should be considered a "worst case situation," and the clinical incidence of neurohistologic changes is expected to be lower.     

Accidental spinal potassium chloride injection successfully treated with spinal lavage

We describe the management of a 62‐year‐old man who developed severe pain, cramps, paraplegia and pulmonary oedema after the accidental administration of potassium chloride into the subarachnoid space. In addition to supportive treatment, we performed cerebrospinal fluid lavage with saline 0.9%. The patient recovered well without any permanent injury.     

胸腰椎结核伴截瘫的前路手术治疗

[目的]探讨胸腰椎脊柱结核伴截瘫的手术治疗方法和疗效。[方法]总结30例胸腰椎结核伴截瘫患者,采用前路病灶清除、椎管减压、椎间植骨并前路固定的手术治疗,术后抗结核治疗18个月。[结果]全部病例随访平均19个月,30例结核全部治愈,其中有2例复发,植骨融合29例,后凸矫正角度12°,神经功能恢复优良率90%。[结论]经前路病灶清除、椎管减压、椎间植骨前路内固定术治疗胸腰椎脊柱结核伴截瘫,能获得较好效果。     

Syringomyelia of the thoracic spinal cord associated with spinal meningiomas

Syringomyelia is known to occur secondary to compression of the spinal cord. We report the case of a female patient who underwent removal of a spinal meningioma. She re-presented 30 years later with multiple meningiomas causing cord compression. After a 4 year interval she was found to have developed a syrinx proximal to the site of compression. Comparison with previous case reports suggest that the causation of syringomyelia is multi-factorial.     

Extensive spinal necrosis with spinal leptomeningeal dissemination of cerebral astrocytoma

Summary A 58-year-old male with malignant astrocytoma in the right parietal lobe developed ascending spinal dysfunction 15 months after subtotal resection of the primary lesion. He was treated by postoperative radiation and combined chemotherapy. Autopsy revealed extensive spinal necrosis affecting the level below the lower cervical region. Microscopic examination demonstrated diffuse leptomeningeal metastasis of glioma cells to the whole spine.There was no previous report in the literature of massive myelomalacia attributable to leptomeningeal dissemination an astrocytic supratentorial tumour. Clinical and neuropathological findings suggested that disturbance of venous drainage of the spinal cord might be responsible for myelomalacia in this case.     

Catecholamines in experimental spinal cord lesions associated with spinal arachnoiditis

Catecholamines in the spinal cord and cerebrospinal fluid of dogs with arachnoiditis induced by cisternal kaolin injection were measured by radioenzymatic assay. The levels of noradrenaline in the gray matter of the cervical cord and the cerebrospinal fluid were highest in 1st week (mean values, 127.8 ng/g and 856.0 pg/ml), whereas those in the gray matter of the thoracic and thoracolumbar cord increased to 175.0 and 210.0 ng/g in average respectively in 12th week. The increase in the level of noradrenaline in the gray matter seemed to be related with degenerative cord lesions in almost all segments, while most segments with cavitation indicated low noradrenaline level.