牵引和体疗治疗神经根型颈椎病800例

Background:The mechanism of cervical spondylopathy is very complex.During the retrograde degeneration of the cervical vertebrae hyperosteogeny occurs at the anterior and posterior edges of the vertebrae and the small joints and hyperemia,swelling,fibrosis,calcification or ossification might occur in the around articular ligaments and stimulate or pressure spinal nerve root,the spinal cord,cervical sympathetic nerves and the vertebral artery and cause different clinical manifestations.     

腰椎间盘突出症术后的康复治疗

Background: Most operation treating the lower back interveterbral disc protrusion apply posterior vertebral lamina fenestration an half vertebral lamina removing or vertebral lamina removing, the vertebral tube was opened and the nucleus pulposus was removed, while all these methods caused weakened spinal column stability. Satisfactory treating results may be gained with the horizontal and vertical chiseling and reserved replanting of vertebral lamina designed according to biodynamic principles. Objective: To discuss the treating effects of reserved replanting of vertebral lamina and rehabilitation treatment after operation in lower back intervertebral disc protrusion. Unit:Second People's Hospital of Ningxia.     

Influence of intraspinal implantation of pSVPoMcat genetically modified schwann cell on regeneration of injured spinal cord

Regeneration of spinal cord regeneration and repair after spinal cord injury(SCI) is always a difficulty in the field of neurosurgery research.Previous studies showed that regeneration of the injured spinal cord depends on Schwann cells(SC)that can provide neural neurotrophic factors and induce axonal growth and promote regeneration after SCI by inhibiting the microenviroment for scar tissues to form[1－ 2], Central nervous system(CNS)of mammals has potential ability of regeneration.The …     

无骨折脱位型颈髓损伤18例分析

BACKGROUND: Traditionaly , operation should not be performed on patients suffered from cervical injury without fracture and dislocation during rehabilitation or patients with complete paralysis. Dang Gengting suggested that although external force resulting cervical injury is slight, fracture and dislocation are rare, spinal damage is severe. So, doctors should consider risk factors of vertebral canal affecting spinal cord. Acute nerve and spinal injury, for example, will progress into chronic spinal disease or nerve root disease if not properly managed. So, once diagnosis was confirmed, traction, mobilization should be carried out to prevent other injury. Treatment protocol should be determined according to type of injury. If object increasing pressure, operation should be done to remove pressure. Additionaly, stability of cervical cord must be ensured.     

Clinical reasoning: a 20-year-old woman with coma and quadriplegia

<正>Dear editor,Subacute combined degeneration(SCD) of the spinal cord, which is mainly caused by vitamin B12 deficiency, reveals damage in posterior and lateral columns and peripheral nerves. The CNS and cranial nerves are rarely involved except in children.^[1,2] Spinal cord MRI abnormal long T1 and T2 signs in the posterior funiculus has specificity for the diagnosis.^[3] There have been many case reports about SCD induced by nitrous oxide anaesthesia or entertainment...     

横惯性脊髓炎（英文）

Transverse Myelitis(TM)is a disorder caused by inflammation of the spinal cord.It is characterized by symptoms and signs of neurologic dysfunction in motor and sensory tracts on both sides of the spinal cord.The involvement of motor and sensory control pathways frequently produce altered sensation,weakness and sometimes urinary or bowel     

Treatments of the posterior urethral injury by simplified urethral realignment

Objective To discuss a simple, safe and effective management for the the posterior urethral injury after pelvic fracture.Methods: The patients were treated by the simplified urethral realignment with traction; in the operation, the two -way catheter with an inner metal frame was implanted by the guidance of forefinger. After the operation, urethral dilation was processed regularly. Results 41 cases have been followed up and 36 cases can midurate normally, so the curative rate was 87. 8%. ln those, impotence occurred 3 cases. Conclusions The proper application of the urethral realignment with tradion followed by regular urethral dilation has an effecf on the patients of the the posterior urethral injury in pelvic fracture.     

咳嗽训练促进颈脊髓损伤伴不全瘫患者排痰

【 abstract 】 objective To explore the effects of cough training on intercostals muscles strength and sputum excretion ability in acute cervical spinal cord injury patients with incomplete paralysis. Methods 127 acute cervical spinal cord injury with incomplete paralysis cases treated in changzheng hospital from January 2012 to December 2015 were admitted into study. They had been divided into experimental group and control group randomly by the method of throwing a coin.Experimental group started cough training from 1 d postoperative and the control group only treated by routine sputum nursing measures.The effect of sputum excretion ability, intercostals muscles strength and the rate of sputum suction,lung infection and atelectasis had been compared 8 days after surgery.Results The sputum excretion ability and intercostals muscles strength of the experimental group were significantly better than the control group 8 days after surgery.The rate of sputum suction,lung infection and atelectasis in experimental group was significantly lower than the control group.There were no complications of early cervical fixation turning up in both groups.Conclusion The cough training can strengthen intercostals muscles of CSCI patients with incomplete paralysis, promote their sputum excretion ability .Futhermore ,It can reduce the rate of sputum suction and the incidence of respiratory complications such as lung infection, atelectasis.     

Bilateral and symmetric C1-C2 dumbbell ganglioneuromas associated with neurofibromatosis type 1: A case report

BACKGROUND Ganglioneuroma(GN) is a rare and benign tumor that originates from autonomic nervous system ganglion cells. The most frequently involved sites are the posterior mediastinum, the abdominal cavity, and the retroperitoneal space. It rarely occurs in the cervical area, compressing the spinal cord. Neurofibromatosis type 1(NF-1) is an autosomal dominant inheritance disorder, whose prevalence rate approximates one per 3000.CASE SUMMARY We report an extremely rare case of bilateral and symmetric dumbbell GNs of the cervical spine with NF-1. A 27-year-old man with NF-1 presented with a one-year history of gradually progressive right upper extremity weakness and numbness in both hands. Magnetic resonance imaging showed bilateral and symmetric dumbbell lesions at the C1-C2 levels compressing the spinal cord. We performed total resection of bilateral tumors, and the postoperative histopathological diagnosis of the resected mass was GN. After operation, the preoperative symptoms were gradually relieved without complications. To our knowledge,this is the sixth report of cervical bilateral dumbbell GNs.CONCLUSION In some cases, cervical bilateral dumbbell GNs could be associated with NF-1.The exact diagnosis cannot be obtained before operation, and pathological outcome is the current gold standard. Surgical resection is the most effective option, and disease outcome is generally good after treatment.     

改良二维影像导航引导椎体后凸成形术治疗多发性椎体压缩性骨折临床分析

Objective To explore clinlical outcomes of using improved computer-assisted fluoroscopic navi-gation to guide the percutaneous vertebroplasty to treat multiple osteoporotic spinal compression fractures. Methods Twenty-eight multiple osteoporotic spinal compression fractures patients with 73 painful vertebral body were got an-terio posterior,lateral and oblique radiographic imaging by using computer-assisted fluoroscopic navigation to imitate anterior- posterior. Lateral spinal and axial pedicle virtual image was obtained to guide the percutaneous kyphoplas-ty. Results All painful vertebral body were one-sided punctured,all percutaneous kyphoplasties were succeed by guiding with computer-assisted fluoroscopic navigation. Navigation virtual puncture needle image basically matched with reality view. PMMA dosage was 2.5 ～ 4 ml. Postioporational CT showed that the PMMA filled spinal focus very well. 11 cases completely relieved and 17 cases partially relieved. Conclusion Using improved computer-assisted fluoroscopic navigation to guide the PKP to treatment multiple osteoporotic spinal compression fractures decreases op-erative time and radiation injury. It is a safe,precise,minimally invasive method.     

胸腰段爆裂骨折的影像异常与神经损伤的关系

目的观察分析胸腰段爆裂骨折患者神经损伤是否存在及严重程度与以下因素的关系：①就诊时CT表现的椎管内骨块占位程度;②后凸畸形程度,评价后路经椎弓根器械治疗对恢复以下临床指标的效果：①伤椎前缘、后缘高度;②后凸成角;③神经功能;④椎管骨块占位。方法本组为99例胸腰段爆裂骨折患者,其中男71例,女28例;年龄17—68岁,平均37岁;致伤原因高处坠落57例,车祸2,4例,砸伤12例,其它6例;非手术治疗2例,除1例行单纯后路椎板减压外,余96例均行后路手术经椎弓根镙钉器械治疗,手术时间为伤后6小时-24天,术中出血为50ml-2000ml。所有患者入院时均行术前CT扫描、术前正侧位x线片,其中有7例有术后CT,非手术治疗和单纯后路椎板减压患者无术后x线片。所有影像资料都包括伤椎及与之相邻的上下椎体。受伤部位T11为5例、T12为15例、L1为53例、L2为26例。脊髓功能的评估以入院时首次体检（非手术治疗）或术前最后一次体检（手术治疗）为准,尽可能排除脊髓震荡所致的短暂脊髓功能障碍,术后以出院前最后一次体检为准。按修改的ASIA分级法进行评分,其中A级13例,B级7例,c级13例,D级29例,E级14例,F级23例。结果神经损伤按修改后的ASIA分级,各功能级之间椎管占位程度和后凸成角均无显著差异（P〉0．05）,术后伤椎前缘高度恢复至（91．4±10．0）％,后缘高度恢复至（96．7±4．4）％,Cobb角恢复至（-2．0±5．6）°,椎管内占位恢复至（14．6±13．8）％,神经功能评分降至（1．5±1．6）,以上各项指标与术前比较差异有显著性（P〈0．05）。结论①胸腰段爆裂骨折神经损伤是否存在及严重程度与就诊时CT表现的椎管内骨块占位程度和后凸畸形程度均具有不一致性,对于胸腰椎爆裂性骨折的早期治疗选择,不仅要考虑?     

经后路椎管侧前方潜行减压椎体内植骨内固定治疗胸腰椎骨折

目的探讨对不稳定性爆裂型、骨折片侵及椎管容积〉50％的胸腰椎脊柱脊髓损伤患者,经后路椎管侧前方潜行减压椎体内植骨内固定治疗的可行性及临床效果．总结技术要点。方法对39例不稳定性爆裂型、骨折片侵及椎管容积〉50％的胸腰椎骨折伴脊髓损伤患者行后路椎管侧前方潜行减压、椎体内及后外侧植骨、椎弓根螺钉内固定术。结果39例患者均获随访,随访7—41月,平均（14．22&#177;7．41）月。椎体前缘高度与原高度比由术前平均（48．42&#177;5．38）％恢复到术后平均（92．23&#177;2．49）％;椎体后缘高度与原高度比由术前平均（74．31&#177;3．56）％恢复到术后平均（97．76&#177;1．06）％;Cobb角由术前平均（19．47&#177;3．94）。矫正到术后平均（3．96&#177;1．87）&#176;．手术治疗前后比较均有明显好转,差异均有统计学意义（t分别=48．62、39．40、22．24,P均〈0．05）。神经功能根据Frankel分级评定,术后较术前有0～3级的恢复。其椎体高度无明显丢失,植骨全部融合,术后39例CT复查显示椎管矢状径得到有效扩大．脊髓压迫解除。结论经后路椎管侧前方潜行减压椎体内植骨内固定治疗不稳定性爆裂型、骨折片侵及椎管容积〉50％的胸腰椎骨折是可行的。     

无骨折脱位型颈脊髓损伤程度的影响因素研究

目的探讨无骨折脱位型颈脊髓损伤程度的影响因素。方法回顾性分析44例无骨折脱位的颈脊髓损伤病例的MRI资料。从矢状位和轴位图像观察记录：脊髓损伤的长度，脊髓损伤处椎间盘突出最大径，椎间盘突出类型，脊髓损伤处椎管前后径、黄韧带厚度、椎体后缘骨赘有无和脊髓损伤节段，同时记录患者的年龄和性别。以脊髓损伤长度为应变量，以性别、年龄、椎间盘突出最大径、椎管前后径、椎间盘突出类型、黄韧带厚度、椎体后缘骨赘有无、脊髓损伤节段为自变量，进行多因素相关性分析。结果①44例中，脊髓损伤的长度为3～22mm，椎间盘突出的最大径为4～8mm，椎管前后径为4～9mm，黄韧带厚度为2—7mm，脊髓损伤平面位于C。～C，水平。②颈脊髓损伤的程度与颈椎间盘突出程度、颈椎管径前后径、颈椎黄韧带的厚度、颈脊髓损伤节段相关，差异有显著性意义（P〈0、01）。结论无骨折脱位的颈脊髓损伤的程度与颈椎间盘突出程度正相关，与颈椎管径前后径负相关，与颈椎黄韧带的厚度、颈脊髓损伤节段相关，与椎间盘突出的类型、椎体后缘有无骨赘、性别和年龄无关。     

自体髂骨移植椎管成形加椎弓根螺钉治疗严重胸腰椎爆裂性骨折

目的 探讨自体髂骨移植椎管成形加椎弓根螺钉内固定术治疗严重胸腰椎爆裂性骨折伴椎管狭窄的手术技巧、疗效及适应症。方法 对1996年以来34例胸腰椎骨折伴椎管狭窄病人采用自体髂骨移植椎管成形加椎弓根螺钉内固定治疗。结果全部病例经18个月～5年的随访，椎体高度恢复良好，cobb’s角纠正理想，除2例术前Franke1分级为A级者外，其余均有一级以上改善，硬膜囊及神经根无压迫，无1例出现腰腿痛者。椎管矢状径较相邻椎管矢状径大。本组损伤节段矢状径与相邻节段矢状径平均值比率在138．46％和160．00％之间，平均为145．16％。结论 自体髂骨移植椎管成形加椎弓根螺钉内固定，对严重胸腰椎爆裂性骨折伴椎管狭窄是一种较理想的手术方法。此方法操作简单、安全，解除神经及硬膜囊压迫的同时扩大了椎管，杜绝了继发性椎管狭窄，重建了后柱结构包括棘突及脊上韧带，增加了脊柱稳定性，值得推广。     

Ultrasound-guided decompression of the spinal canal in traumatic stenosis

The purpose of this study was to examine the efficacy of ultrasound (US)-guided decompression of the myelon in the surgical treatment of spinal fractures. Intraoperative ultrasonography was performed in 22 patients with traumatic stenosis of the spinal canal during spinal cord surgery with removal of retropulsed bony fragments. US imaging requires a posterior approach and an enlarged foramen interarcuale. The posterior vertebral facet and the myelon can accurately be distinguished from small bony fragments by ultrasonography. Pre- and postoperative computed tomography was compared with intraoperative US imaging. Complete decompression of the spinal canal was controlled by US imaging of the restored ventral epidural space, as seen after repositioning of displaced fragments. Thus, the required extent of the surgical procedure was determined by intraoperative ultrasonography. We conclude that intraoperative US imaging is an important tool to monitor the restoration of the spinal canal and decompression of the spinal cord in case of fracture. The repositioning of stenosing bony fragments using surgical instruments can be monitored. US imaging as a real-time method intraoperatively provides the surgeon with additional information and significantly influences treatment options.     

椎弓根钉棒系统置入复位内固定胸腰段椎体爆裂骨折的椎管形态变化

背景：目前胸腰椎爆裂骨折在椎弓根器械复位固定后观察指标为椎体基本形态的影像学检查,对于复位后椎管形态变化的研究鲜有报道。目的：分析胸腰段椎体骨折予以椎弓根钉棒系统内固定复位治疗后椎管形态变化的规律。方法：对28例胸腰段椎体爆裂骨折予以椎弓根钉棒系统内固定复位的患者进行治疗后随访,所有患者分别于治疗前、治疗后1周,治疗后1年及治疗后2年拍胸腰椎正侧位X射线片,所有患者术前均行伤椎上下椎体的CT断层扫描,其中26例获得了治疗前、治疗后1周,及治疗后1年左右的CT横断扫描影像资料,2例部分影像学资料丢失。先于胸腰椎侧位X射线片上辨别椎体后缘有无骨折块突入椎管,同时观察椎体形态变化;CT横断扫描影像资料上测量椎管正中矢状径表示椎管占位程度。结果与结论：28例侧位X射线片上可看出椎体后缘骨块突入椎管者治疗前有18例（64．2％）,治疗后6例（21．4％）,治疗后1年时2例（7．1％）,至治疗后2年1例（3．5％）;治疗前正中矢状径平均为42．6％（n=28）。有完整随访影像学资料的26例中治疗后CT片正中矢状径平均为75．2％（P〈0．05）,治疗后1年平均正中矢状径为91．2％（n=26）。提示胸腰段椎体爆裂骨折行椎弓根钉棒系统内固定及复位治疗后椎管占位复位作用明显,治疗后远期观察椎管形态基本可恢复正常。     

钛网植骨结合椎弓根钉棒内固定修复胸椎结核：重建脊柱生理曲度及稳定性

背景：胸椎结核经前入路或前后联合入路病灶清除、植骨、内固定是常用的修复方案,已沿用数十年,但存在创伤大、切除肋骨、减压不彻底、胸腹腔干扰大、术后疼痛、气胸、胸腔及肺部感染等不足。目的：观察钛网自体骨植骨融合与椎弓根钉棒系统内固定修复胸椎结核,重建脊柱生理曲度及稳定性的随访结果。方法：对32例胸椎结核患者采用后路椎体切除病灶清除,充分解除脊髓压迫,植入钛网自体骨,椎弓根钉棒系统内固定治疗。取后正中切口,应至少包括病变部位头、尾侧各2节脊椎,暴露双侧椎板至小关节外侧及肋骨近端1.0-2.0 cm,并与病椎头、尾侧脊椎双侧分别置入椎弓根螺钉,头、尾侧各2对,一侧固定。在另一侧病椎及下一椎切除一侧椎板、关节突、肋骨头,肋骨切除约1 cm,游离神经根,椎管减压,注意保护脊髓及神经根,吸出椎旁脓肿中脓液。切除椎弓根,受累椎间盘,椎体病灶,直至椎体病灶边缘组织外观正常,无死骨,无结核物质及肉芽组织,椎体破坏严重,两侧椎旁脓肿流注节段较多,经一侧病灶不能清除干净的部分患者,减压侧连接钉棒,以保持病变椎体切除时椎体的暂时稳定。同法从另一侧彻底清除同侧病灶,完全游离硬脊膜,反复冲洗。观察患者的植骨融合时间、骨折愈合、神经功能恢复情况及相关并发症。结果与结论：随访12-38个月,全部患者于治疗后11-19个月（平均16.3个月）植骨融合,脊柱后凸畸形获得70%-100%（平均86%）矫正,脊髓神经功能恢复正常,未出现复发及内固定失效病例。提示Ⅰ期经后路病灶清除、钛网植骨、椎弓根钉棒系统内固定修复胸椎结核,具有病灶清除彻底,创伤小,畸形矫正,植骨融合满意等优点,是修复胸椎脊柱结核的有效方案。     

胸腰椎骨折后路椎管减压AF内固定

目的:研究AF椎弓根螺钉固定的临床治疗方法和治疗效果。方法:对41例胸腰椎骨折行内固定,有椎体或椎板骨折导致椎管狭窄和脊髓压迫,应进行椎管减压,并常规行小关节及横突间植骨。术后常规引流48 h,植骨者术后卧床4周,佩带支具1年。结果:41例中随访36例,随访时间3~36月,平均17.5月。根据手术前后影像学评价(椎体高度的恢复,椎管侵占率,脊核后凸cobbs'角)和神经功能评价(Francel分级),优良率80.5%,其中2例分别于手术后7个月和9个月出现固定系统的松动,经取出固定系统、卧床佩带支具后病情稳定,骨折愈合。结论:AF椎弓根螺钉固定牢固可靠,能达到精确复位固定及椎管有效减压,疗效确切。     

AF椎弓根螺钉内固定系统治疗胸腰椎爆裂性骨折：30个月随访的中远期效果分析

背景：研究证实后路短节段椎弓根螺钉系统治疗无神经症状的胸腰椎爆裂性骨折,能够提供足够的稳定性,有效恢复椎体高度、生理弧度和椎管容积。目的：评价AF椎弓根螺钉内固定系统治疗胸腰椎骨折的效果。方法：分析51例应用AF经椎弓根内固定系统治疗胸腰椎爆裂性骨折患者内固定治疗的中远期疗效。利用X射线片检查内固定前后、拆除内固定前、拆除内固定后随访时的椎体前后缘高度和计算Cobb’s角,CT观察椎管占位情况,利用Frankel分级评估神经功能恢复情况,Christian评分评价功能情况,Denis分级评估疼痛程度。结果与结论：患者均随访30个月以上。与内固定前比较,内固定后、拆除内植物及末次随访时Cobb’s角及椎体前、后缘高度明显增加（P〈0.01）,CT观察椎管占位明显恢复。内固定前存在脊髓不完全损伤24例,内固定后完全恢复22例。功能活动Christian评分：3分1例,4分3例,5分15例,6分20例,7分12例。腰痛程度按Denis评估,无痛42例,偶有微痛9例。满意度患者自我评测：非常满意35例,满意16例。内固定钉断裂1例1枚。表明AF椎弓根内固定系统能达到满意复位、牢固固定、有效椎管减压的目的,能有效治疗胸腰椎骨折。     

伴不全瘫胸腰段椎体骨折的治疗(附112例疗效分析)

目的探讨伴不全瘫胸腰段椎体骨折的手术及非手术治疗效果及损伤复位机制、最佳治疗方法和手术内固定方式.方法本组伴不全瘫胸腰段椎体骨折112例行手术或非手术治疗.A组(非手术组)38例,过伸位牵引复位后平卧于硬板床.B组(手术组)74例,经前路或保留后结构的后路减压内固定.结果本组病例获随访时间3～12年,平均5.5年.治疗后随访伤椎前、后高度及后凸成角和椎管矢状径均较治疗前有显著改善(P＜0.01),而手术治疗组比非手术治疗组改善更明显.治疗后随访脊髓神经功能较治疗前有明显好转(P＜0.05),而手术治疗组效果更显著.结论伴脊髓损伤的胸腰段椎体骨折存在潜在性不稳定,有可能加重脊髓神经损伤或妨碍脊髓神经功能恢复,应尽可能早期行保留后结构后路手术减压内固定,以恢复脊柱序列及椎管容积.