颈胸段脊柱肿瘤的外科治疗

目的 观察比较不同手术入路方法治疗颈胸段脊柱肿瘤的疗效。方法 本组９例,共１０例次。对其中４例肿瘤同时累及椎体及椎体后部结构的患者,选择前后路同期手术,经前路切除肿瘤、椎管减压及钢筋骨水泥或前路钢板固定,并同期行后路肿瘤切除术,其中１例行Ｌａｕｑｕｅ棒固定;对４例肿瘤仅累及椎体者,选择经前路切除肿瘤、椎管减压、钢筋骨水泥固定;另２例肿瘤单纯累及椎体后部结构者,经后路行肿瘤切除和椎管减压术。术后４例     

胸腰椎骨折前路内固定研究进展

胸腰椎骨折是常见而较为严重的创伤,前路手术可直视下保证椎管得到彻底减压,同时前柱承载着脊柱主要的载荷分布,而前路手术能实现前柱的骨性融合并重建脊柱前柱的高度,故前路手术仍是胸腰椎骨折治疗中的重要方法。随着脊柱钉棒系统的应用,临床上大多采用后路开放手术治疗,但前路内固定因具有独到的优势,单纯后路并非能取代。本文综述总结前路手术治疗胸腰椎骨折的生物力学特点、手术适应证选择、前路内固定器械、植骨方法及技术要点,以期为临床治疗胸腰椎骨折提供更佳确切的证据。     

颈椎前路分节段减压融合术三维有限元分析

目的应用三维有限元模型分析颈椎前路分节段减压融合术的生物力学特点。方法建立C2～7三维有限元模型，在此基础上根据临床实际建立手术模型，观察不同手术方式的颈椎活动范围和邻近节段椎间盘应力。结果建立的颈椎三维有限元模型有效，分节段减压融合术比传统椎体次全切除术术后邻近节段椎间盘应力小，二者颈椎活动范围相同。结论颈椎前路分节段减压融合术比传统椎体次全切除术更符合人体生物力学要求。     

多孔纳米羟基磷灰石/聚酰胺66骨柱在脊柱前路椎体融合术中的应用

目的 研究多孔纳米羟基磷灰石,聚酰胺66骨柱在脊柱前路椎体融合术中的应用情况.方法 采用多孔纳米羟基磷灰石/聚酰胺66骨柱在脊柱前路椎体减压术如椎体的爆裂骨折、椎体结核、椎体的陈旧性骨折椎体肿瘤的椎体全切除术中代替原来临床上常用的钛网等前路的支撑物并使用原来的前路内固定器材.结果 椎体前路手术中,在脊柱前路椎体采用多孔...     

脊柱前路单棒内固定系统的临床应用

对脊柱肿瘤、结核、椎体骨折等导致脊髓前方受压或脊柱失稳,采用脊柱前路减压内固定是常用的手术方法。前路内固定器材种类繁多,但多为进口或价格昂贵,使部分低收入患者无法承受。笔者自2004年5月~2006年10月,使用北京富乐公司生产的前路单棒内固定系统进行脊柱前路手术12例,效     

现代脊柱内固定技术（续）

3　胸腰椎及腰椎3 .1　前路钢板3 .1.1　适应证　椎体骨折或肿瘤 ,前路减压植骨术。3 .1.2　手术步骤 (以Ｚ ｐｌａｔｅ为例 ) [15] 患者侧卧位 ,经胸、胸腹联合或腹膜外入路暴露拟切除椎体 ,切除椎体及其上、下方椎间盘 ,测量上、下方椎体横径并据此选择相应长度的螺钉和螺栓。选择下方椎体后下缘前、上方 8～ 10ｍｍ处及上方椎体后上缘前、下方 8～ 10ｍｍ作为进入点 (见图 9Ａ) ,钻孔后旋入螺栓 ,其角度应偏向前方 10°左右 (见图 9Ｂ)。以上、下位椎体的螺栓为支点用撑开器撑开复位 ,植入髂骨块 (见图 9Ｃ)。去除撑开器后置入相应规格的…     

腰椎融合手术方式的比较研究

随着手术技术的进步和手术理念的不断更新，腰椎融合手术已成为脊柱外科手术中广泛应用的手术方式，而且手术数量呈逐年增长的趋势。其手术适应证也逐渐扩展至对腰椎退变性疾病，如椎间盘突出、椎管狭窄以及椎间盘源性腰痛等的治疗。腰椎融合手术主要包括后外侧融合术（posterolateral lumbar fusion，PLF）和椎体间融合术（interbody fusion），后者又可分为后路椎间融合术（posterior lumbar interbody fusion，PLIF）、     

前路切除椎体后缘骨块立柱挡板植骨术治疗胸腰段爆裂型骨折截瘫

1962～1992年共采用前路椎体间立柱撑开植骨,椎体后缘骨块切除,脊髓前减压术治疗胸腰段脊柱骨折合并截瘫或不全截瘫100例。收到减压脊髓、稳定脊柱和植骨融合的效果。本文就经前路切除椎体后缘骨块,椎体间立柱撑开植骨加挡板的手术步骤和新手术入路,进行详细介绍。     

骨科

数学化人体脊柱的初步临床应用；经口咽前路寰枢椎复位钢板系统治疗陈旧性齿状突骨折；Hangman骨折的前路手术治疗；EH复合型颈椎螺纹融合器的研制和临床应用；Ⅰ期前后联合入路脊髓减压病灶切除内固定治疗颈椎后纵韧带骨化症；多节段前路减压植骨融合并钢板内固定术治疗脊髓型颈椎病；Atlas钛缆内固定系统在寰枢椎脱位中的应用；前路植骨融合带锁钢板内固定治疗颈椎外伤性滑脱；用颈长肌重建预防颈前路植骨块滑脱的临床应用；青年非创伤性颈椎生理弧度异常的病因及机理探讨；CT三维重建椎弓根钉导航系统在胸椎手术中的应用；结束支具治疗后青少年特发性脊柱侧凸的进展及影响因素分析；CT三维重建在先天性脊柱侧凸诊疗中的价值；椎体后凸成形术棘突定位穿刺点与穿刺轨道的研究；椎体软骨终板在脊柱退行性疾病及脊柱侧凸发病中的作用（综述）；经椎间孔腰椎椎体问融合术的应用进展（综述）；老年骨质疏松椎体压缩骨折的经皮椎体后凸成形术；老年骨质疏松性胸腰椎爆裂骨折的前路减压内固定治疗；球囊扩张椎体后凸成形术治疗骨质疏松性脊柱压缩性骨折；异体骨管在胸腰椎爆裂骨折前路手术中的应用；钉棒及钩棒系统治疗胸腰椎多节段脊柱骨折；单节段腰椎后部结构逐级切除对脊柱三维运动稳定性的影响；腰椎滑脱症24例手术治疗体会；椎间盘镜治疗腰椎间盘突出伴椎管狭窄症；腰椎旁或骶管注射结合整脊推拿治疗腰椎闻盘突出症；腰椎管狭窄症的手术方式探讨；脊柱显微内镜在治疗腰椎管狭窄症的临床应用（附129例报告）；椎间盘源性腰痛动态摄片及其临床意义；椎体气囊扩张成形术治疗老年椎体压缩骨折；椎弓根螺钉断裂25例原因分析；仿生活性人工骨诱导兔椎板问多节段脊柱融合的研究；椎弓根螺钉对腰椎关节突关节破坏率的研究。[编者按]     

胸腰椎骨折的前路椎管减压内固定术

传统的后路减压已被公认为减压不彻底,并可加重脊柱的不稳定性。本文对国外近年开展的胸腰椎骨折前路减压内固定术作一综述,该术可在直视下直接去除脊髓前方的致压物质,同时作椎体内固定。手术采用腹膜后入路,减压包括切除一侧椎弓根、后1/3～2/3椎体及相应的上下椎间盘和软骨板,椎体间植骨宜用含皮质骨的大块骨。内固定安置在损伤脊椎的上下椎体侧后方,术后病人可早期活动。本文还介绍了手术适应证、并发症以及新型前路内固定器。     

侧方途径切除胸腰椎肿瘤和脊柱重建

目的探讨侧方入路手术途径切除胸腰椎肿瘤和重建脊柱稳定性的临床疗效和意义。方法29例T3～T4肿瘤患者，Frankel神经功能分级：A级3例，B级5例，C级7例，D级6例，E级8例。经侧方入路手术途径显露病椎前方、侧方和后方，切除肿瘤以及上下相邻椎间盘，然后根据肿瘤的具体情况进行不同肜式的脊柱稳定性的重建。结果围手术期无死亡病例，患者出院时Frankel神经功能分级，A级2例，B级3例．C级4例，D级4例，E级16例。术后获访23例，随访时间13～58个月，死亡4例；神经功能情况，13例较出院时有改善，加重1例。结论侧方入路手术途径无需经胸／腹膜腔，患者容易耐受手术，适合于某些胸腰椎肿瘤的切除和脊柱稳定性的重建。     

Incidence and significance of findings on spinal MRIs in a paediatric population with spinal column complaints

PurposeWe sought to identify correlations between working diagnosis, surgeon indication for obtaining spinal MRI and positive MRI findings in paediatric patients presenting with spinal disorders or complaints.MethodsSurgeons recorded their primary indication for ordering a spinal MRI in 385 consecutive patients. We compared radiologist-reported positive MRI findings with surgeon response, indication, working diagnosis and patient demographics.ResultsThe most common surgeon-stated indications were pain (70) and coronal curve characteristics (63). Radiologists reported 137 (36%) normal and 248 (64%) abnormal MRIs. In total, 58% of abnormal reports (145) did not elicit a therapeutic or investigative response, which we characterized as ‘clinically inconsequential’. In all, 42 of 268 (16%) presumed idiopathic scoliosis patients had intradural pathology noted on MRI.Younger age (10.3 years versus 12.0 years) was the only significant demographic difference between patients with or without intradural pathology. Surgeon indication ‘curve magnitude at presentation’ was associated with intradural abnormality identification. However, average Cobb angles between patients with or without an intradural abnormality was not significantly different (39° versus 37°, respectively). Back pain without neurological signs or symptoms was a negative predictor of intradural pathology.ConclusionRadiologists reported a high frequency of abnormalities on MRI (64%), but 58% of those were deemed clinically inconsequential. Patients with MRI abnormalities were two years’ younger than those with a normal or inconsequential MRI. ‘Curve magnitude at presentation’ in presumed idiopathic scoliosis patients was the only predictor of intrathecal pathology. ‘Pain’ was the only indication significantly associated with clinically inconsequential findings on MRI.Level of evidence:III     

Atypical forms of spinal tuberculosis

Summary Twenty-three patients with atypical forms of spinal tuberculosis treated between 1975 and 1985, are described.All presented with signs and symptoms of compression of the spinal cord or cauda equina, ranging from paraesthesiae and increasing weakness of extremities to paraplegia and loss of sphincter control. None of them showed visible or palpable spinal deformity nor the typical radiographic appearance of destruction of the intervertebral disc and the two adjoining vertebral bodies. These atypical forms constituted about 12 percent of all the cases of spinal tuberculosis seen (a total of 190 cases); and fell into three well-defined groups: those with the involvement of neural arch only; those with the inolvement of a single vertebral body; and, those without bony involvement. The correct surgical approach in these groups was found to be different: spinal cord compression caused by the tuberculous disease of the neural arch was best treated by laminectomy; whereas single vertebral body disease required an anterior or anterolateral approach. Spinal computerized tomography was helpful in defining the extent of disease and planning the surgical approach. Histological confirmation of tuberculosis was obtained in all the cases and acid fast bacilli (A.F.B.) were found in, and cultured from, the biopsy specimens of 18 cases.     

椎管内肿瘤的诊断及手术治疗

探讨椎管内肿瘤的临床特点及手方法。方法１０３例椎管内肿瘤患者均经手术治疗,颈椎行单开门术暴露椎管,胸椎行全椎板切除,腰椎椎则行次全椎板切队鹘椎椎管内外哑铃型肿瘤分别采用颈前路和肋骨横突切除术入路。结果随访８２例平均随访时间３．５年,优良率为８１．７％。     

MR-imaging of chronic spinal cord injury. Association with neurologic function

Twenty-two para- and tetraplegic patients with chronic spinal cord injuries were examined with magnetic resonance imaging (MRI). The clinical course in the entire rehabilitation period was recorded and an attempt was made to associate the functional status of the patients with the morphologic findings on MRI. Small and large spinal cord cysts and syringomyelia, cord atrophy, and spinal stenosis were found. Additionally, in a number of patients regions of increased signal intensity within the cord, interpreted as myelomalacia, and obliteration of the intradural extramedullary space, interpreted as arachnopathy, were noted. The large number (13/22) of cystic lesions in our patients was unexpected. It was in contrast to the rate reported in autopsy studies of paraplegics which note only few cysts. Whereas a direct association of morphologic findings with neurologic symptoms and the clinical course was difficult, it was found that patients with large cysts and spinal cord atrophy generally showed no tendency to improve in spite of the measures taken during the rehabilitation period. It is difficult to decide whether the initial trauma with cord hemorrhage is limiting the chance of neurological improvement or if a sequence of events leading from hemorrhage to gliosis and cystic necrosis is the determining factor.     

Somatosensory evoked potential

Summary Somatosensory evoked potentials (SSEPs) have been used to help minimize neurologic morbidity during spinal surgery. While this is a sensory test it has been used as an inference of motor function. The failure to always achieve the latter goal has resulted in some pessimism regarding the value of this test. In this series of 161 operations in 150 patients, it was demonstrated that SSEPs were recordable under anesthesia in 87% of patients. Of these patients, 12% had their spinal surgery interrupted due to significant neurophysiologic changes; of these patients, 18% had new neurologic deficits postoperatively. There were no cases with new neurologic deficits who had no changes in their SSEPs. It was concluded that SSEP monitoring may be helpful in identifying potentially neurologically threatening surgical maneuvers in a significant number of patients.     

椎体成形术治疗老年骨质疏松脊柱压缩骨折

目的探讨椎体成形术治疗老年骨质疏松脊柱压缩骨折的疗效和安全性.方法在C臂X线机监测下对20例36个椎体行椎体成形术(均为后壁完整疼痛剧烈老年骨质疏松脊柱压缩骨折).观察术后症状改善情况,分析并发症.结果20例椎体成形术术后均未出现肺栓塞、神经损伤等并发症,CT检查无椎管内或椎间孔渗漏.术后随访5～18个月,17例疼痛消失,2例明显减轻,1例缓解.结论椎体成形术是治疗老年骨质疏松脊柱压缩骨折安全有效的方法.     

Double Noncontiguous Cervical Spinal Injuries

Summary. Summary.   Background: Double noncontiguous spinal injuries in the same patient, the first at the cervical level and the second at the thoracic or thoracolumbar level are not uncommon. On the other hand the incidence of double noncontiguous cervical injuries in low and these injuries imply complex mechanisms. This study investigates the cases of double noncontiguous cervical lesions in 342 cases of acute cervical injuries.   Method: An analysis of 342 patients with cervical injuries found 67 multiple cervical injuries and only 11 cases of double noncontiguous cervical lesions.   Findings and Interpretation: Double noncontiguous cervical injuries have a frequency of 3.2% in this study and in three cases there were pre-existing benign cervical lesions. A possible spinal biomechanical behaviour during injury can be that the first lesion appears because of the traumatic impact and there is a uniform transmission of the remaining traumatic strain all along the spine. It seems that the propagated force finds a spinal zone where the spinal resistance is diminished and the second spinal lesion can occur. Spinal vulnerability for the second lesion in the same trauma can be caused by a pre-existing benign spinal lesion or by a biomechanical discontinuity because of a particular posture at the traumatic moment. The second lesion in double noncontiguous cervical lesions can appear through a single great impact in pre-existing lesions, double impacts at the same time with injuries at two cervical levels or repeated cervical impacts in very quick succession in the same trauma. Published online July 18, 2002     

Flow characteristics of Luer and non‐Luer spinal needles

We investigated the flow rates of 25‐G and 27‐G spinal needles, of 90‐mm and 120‐mm lengths, from Vygon, BD, B. Braun and Pajunk; the needles had either a Luer connector, or a Surety^® or UniVia^® non‐Luer connector. We used a bench‐top model of entering the spinal space, pressurised to 35 cmH₂O to simulate cerebrospinal fluid pressure in the sitting position. We examined the time to first appearance of simulated cerebrospinal fluid in the needle hub, as well as the amount of fluid collected over 120 s after the needle was introduced. The mean (SD) times to first appearance of fluid in the needle hub of Luer spinal needles varied from 0.36 (0.22) s for the 25‐G 90‐mm BD to 3.14 (0.72) s for the 27‐G 120‐mm B. Braun, and in the non‐Luer spinal needles from 0.22 (0.17) s for the 25‐G 90‐mm B. Braun to 2.99 (0.71) s for the 27‐G 120‐mm Pajunk. There was a significant difference in the time to first appearance of fluid in the needle hub between Luer and non‐Luer needles of the same type for seven of 14 comparisons made, of which four showed slower appearance of fluid in the non‐Luer version. In some of these cases, the time to appearance of fluid was nearly twice as long with the non‐Luer counterpart. The mean (SD) weight of fluid collected in 120 s using the Luer spinal needles varied from 0.21 (0.05) g for the 27‐G 120‐mm Pajunk to 1.21 (0.18) g for the 25‐G 90‐mm Vygon, and using the non‐Luer spinal needles from 0.25 (0.05) g for the 27‐G 120‐mm Pajunk to 1.55 (0.05) g for the 25‐G 90‐mm B. Braun. All of the needle types showed a greater weight of fluid collected using the non‐Luer compared with the Luer version, with six of the 14 needle types showing a significant difference. Significant variations in flow were also seen between the same needle type from different manufacturers. We conclude that changing from Luer to non‐Luer versions of spinal needles does not merely change the hub design and connection, but may introduce important differences in function.     

胸腰椎爆裂骨折损伤部位和椎管内占位程度与神经损伤的关系

目的探讨胸腰椎爆裂骨折骨折部位及椎管内骨块占位程度与神经损伤的关系。方法对213例胸腰椎爆裂骨折根据骨折部位及CT测出的椎管内骨折骨块占位程度与神经损伤进行分析评定。结果神经损伤组椎管骨折骨块占位程度明显高于无神经损伤组;在有神经损伤情况下,骨折部位椎管内骨块占位程度腰段大于胸腰段;神经损伤程度与椎管内骨块占位程度无显著相关。结论胸腰椎爆裂骨折椎管内骨块占位压迫是神经损伤的重要因素;神经损伤与骨折部位和椎管内骨块占位程度联合相关。