氟骨症状胸椎管狭窄症的诊断与治疗

目的：探讨氟骨症状胸椎管狭窄症的诊断与治疗经验。方法：对12例氟骨症性胸椎管狭窄症患者的症状、体征、X线片、CT及MRI诊断特点进行了分析,患者均行后路椎板切除术,术后进行疗效评价。结果：12例患者术后2周疗效评价,优1例,良4例,可4例,差3例,有效率75％。结论：早期手术是治疗氟骨症性胸椎管狭窄症的有效方法。     

氟骨症性胸椎管狭窄症的诊断与治疗

目的：探讨氟骨症性胸椎管狭窄症的诊断与治疗经验。方法：对14例氟骨症性胸椎管狭窄症患者的症状、体征、X线片、CT及MRI诊断特点进行了分析,用磨钻行椎板打磨后路整块切除术,术后进行疗效评价。结果：14例患者术后2周疗效评价,优5例,良6例,差3例,有效率78．6％。结论：磨钻打磨、后路椎板整块切除术是治疗氟骨症性胸椎管狭窄症的有效方法。     

胸椎管狭窄症的诊断与治疗

胸椎管狭窄症在临床上并不少见，本作者于1982年在国内首先报告了此症［1］，又于1988年报告了整块半关节突椎板切除术治疗胸椎管狭窄症［2］。至今仍有胸椎管狭窄症手术后加重致全瘫的病例，不同的诊断名称（例如黄韧带骨化症）和不同的手术名称也经常出现。自20世纪80年代初至2000年底，我们共手术治疗62例胸椎管狭窄症，前10年的30例主要依靠X线、脊髓造影、CT和临床体征进行诊断，后10年的32例增加了MR检查代替脊髓造影。根据我们的临床观察，认为对本症的病理改变、诊断和手术治疗，有再认识和再讨论的必要。一、病理改变（一）发病…     

胸椎管狭窄症漏诊误诊及再手术原因分析

目的：分析胸椎管狭窄症漏诊、误诊及再手术的原因。方法：采用回顾性研究方法对漏、误诊及再手术的胸椎管狭窄症的病例进行了分析。结果：２４例再手术的原因有：１０例合并脊髓型颈椎病或颈椎后纵韧带骨化症,做了颈椎减压手术,漏诊了此症;４例误诊为腰椎病变,行腰椎减压手术无效;首次胸椎减压手术范围不够及节段错误各１例;３例首次肷椎减压手术后,其它节段又发生狭窄;３例因全生骨疾患致胸椎管狭窄,术后其原因进一步发展;２例为胸脊髓前、后方同时压迫而单行后方减压。结论：上述原因可导致胸椎管狭窄症的漏、误诊及再手术,应避免发生。     

胸椎管狭窄症术后脊髓缺血再灌注损伤的临床分析

目的 探讨胸椎管狭窄症患者手术后出现脊髓功能受损的原因,总结脊髓手术后缺血再灌注损伤(spinal cord ischemic reperfusion injury,SCII)[1]的预处理和早期治疗方法.方法 回顾性分析我科2年内收治的32例胸椎管狭窄症患者术后脊髓恢复情况,出现脊髓损伤患者的临床资料及处理方法,并对其预后进行客观评估.结果 2年内在收治并手术的胸椎管狭窄症患者中,手术减压前给予1克甲基强的松龙预防.5例患者于手术后出现不同程度的脊髓功能受损,即刻给予大剂量甲基强的松龙冲击治疗、脱水药及神经营养药,1例患者症状改善不理想,2例患者症状部分改善,生活可自理,2例患者基本恢复正常.结论 胸椎管狭窄症患者手术后出现的脊髓功能受损可能是脊髓缺血再灌注损伤引起,再灌注损伤在胸椎管狭窄症患者中较多见,但出现严重监床症状的少见,诊断有一定的困难.妥善的处理可望改善患者的生存质量.     

氟骨症性胸椎管狭窄症的诊治

目的探讨氟骨症性胸椎管狭窄症的诊断及早期全椎板减压术治疗的疗效。方法对35例患者的手术方法及疗效进行分析。结果22例术后明显恢复,8例症状缓解,5例术后无恢复。结论全椎板减压术是治疗氟骨症性胸椎管狭窄症有效的手术方式。     

脊髓MRI T2WI高信号与胸椎管狭窄症手术疗效的关系

胸椎管狭窄症（thoracic spinal stenosis,TSS）是由于发育、退变、韧带增厚等多种因素造成胸椎管节段性管腔狭小,并压迫胸段脊髓导致脊髓功能障碍的一组临床症候群。对于有症状的胸椎管狭窄,原则上一经诊断应尽早手术治疗。但是,胸椎管狭窄症手术在国际上也是脊柱外科的难题,术后瘫痪等神经并发症的发生率高达18%~50%,并且术前很难对手术预后进行较为精准的预测和评估[1]。MRI能够较为清晰地显示病变节段脊髓的受压程度,是胸椎管狭窄症重要的影像学评估手段。     

胸椎管狭窄症的诊断和目的椎间定位

胸椎管狭窄症的诊断依据是患者脊髓压迫症状和影像学表现,两者结合才能做出正确判断.     

氟骨病胸椎管狭窄症手术后血肿形成的早期诊断和治疗

目的分析氟骨病胸椎管狭窄症手术后伤口血肿形成的原因,总结早期诊断和治疗的方法。方法采用后路全椎板减压术治疗312例氟骨病胸椎管狭窄症患者,术后短期内出现神经症状恶化并经MRI检查证实为血肿形成18例,一经确诊马上实施血肿清除术。结果所有病例二次手术后神经症状均获得不同程度的恢复,得到早期诊断、早期治疗的病例恢复效果明显优于延迟治疗的病例。结论手术后血肿形成是氟骨病胸椎管狭窄症治疗中的一种严重并发症,只有早期诊断、及时手术清除才能获得满意的效果。     

胸椎管狭窄症误诊误治15例探讨

目的 总结胸椎管狭窄症误诊误治的原因及预防对策，并对治疗特点进行探讨。方法 对15例胸椎管狭窄症误诊误治和及时采取恰当手术补救的临床资料进行回顾性研究。结果 误诊为腰椎问盘突出症6例，误诊为腰椎管狭窄症7例，病变节段漏诊2例。纠正诊断后采用传统胸椎管后壁切除减压术5例、整块半关节突椎板切除术10例(其中包括加行侧前方减压术4例)，平均随访3年6个月，优8例，良5例，改善1例，差1例。结论多种因素可造成胸椎管狭窄症误诊为腰椎疾患或漏诊胸椎管的病变节段。手术原则是彻底减压和脊髓保护。     

Falls from height: spine, spine, spine!

BACKGROUND: Falls from a height are a major cause of morbidity and hospital cost. Spinal injury is frequently associated with falls from height, but reliable predictive factors have not been identified. Diagnostic evaluation of the spine is complex and debated. Our objective was to characterize spinal injury after falls from height and identify predictive factors of spinal injuries. STUDY DESIGN: Medical records of patients with falls from height>10 feet admitted in a Level I trauma center during a period of 66 months were reviewed. Univariate and multivariate analyses were performed to identify independent risk factors of spinal injuries. RESULTS: Of 414 patients, 127 (31%) suffered 277 spinal injuries. Multiple spinal injuries at different levels were found in 62 (49%) patients; in 19 (15%) spinal injuries were at noncontinuous levels. The only independent predictor of spinal injury was alcohol intoxication (odds ratio=3.305; 95% CI, 1.75-6.242; p<0.001) but the number of intoxicated patients was low and the predictive ability weak. Level of falls from height did not correlate with likelihood of spinal injury. Twenty-four of 107 (22%) patients with spinal injuries and a reliable clinical examination had no symptoms related to the spine; all but 2 had distracting injuries. CONCLUSIONS: Spinal injury is frequent among survivors of falls from height>10 feet. Because of the absence of reliable predictors of spinal injury, the possibility of multiple noncontinuous fractures, and the presence of distracting injuries clouding the clinical presentation, aggressive evaluation of the entire spine is warranted.     

借助胸腔镜技术的胸段、上腰段脊柱前路手术

目的探讨胸腔镜辅助胸椎、上腰椎前路手术的适应证 ,单肺或双肺通气的选择以及术中注意事项。方法　应用胸腔镜、骨科常规手术器械或自制的骨科器械 ,在胸腔镜辅助下行病灶清除、脊髓减压、植骨、钢板螺丝钉内固定术。结果　全部病例手术都顺利完成 ,切口均一期愈合 ,随访 3～ 10个月 ,影像学检查显示病灶清除彻底 ,脊髓减压充分 ,除 1例骨折复位、固定后仍有轻度侧方成角畸形外 ,其他病例复位满意、内固定可靠 ,位置良好。结论胸椎、上腰椎疾患 ,不论是否并发脊髓、马尾神经压迫 ,都能在胸腔镜辅助下完成病灶清除术 ,必要时还可进行脊髓减压、脊柱前路植骨、内固定手术。原则上可选择常规气管插管、双肺通气下完成手术。     

Functional recovery after decompressive spine operation for cervical spine fractures

Ninety-nine patients with cervical spine fractures from C-4 through C-7 were operated upon from 1975 to 1981. Operation was performed to restore normal relationships between the spinal cord and roots and the spinal canal and foramina and to maintain these relationships by fusion when necessary. Neurological function was recorded pre- and postoperatively using a functional scale. Satisfactory fusion without adverse change in vertebral alignment was achieved in each patient. The average interval between injury and operation was 29 days. When neurological recovery was observed, it began promptly after operation, suggesting a cause and effect relationship.     

Cervical spine radiology

The lateral cervical spine radiograph is frequently utilized in the assessment of trauma patients and in perioperative care. Used in conjunction with a thorough clinical assessment it can demonstrate an unstable spine, be it due to trauma or rheumatological disease, thus alerting the anaesthetist of the need for advanced precautions in airway management. In this article we review a systematic approach to the lateral cervical spine radiograph focussing on unstable cervical spines.     

The optimum spine

System theory is used to describe the mechanism of the lumbar spine. The role of the spine in vertebrate evolution is presented. The importance of the intervertebral joint for the survival of the species is shown to be crucial. The mechanical behavior of the joint is derived, and from this the corresponding spinal motion and muscular responses is calculated. It is shown that physiologic behavior implies that the stress at the intervertebral joints is equalized and minimized. From this simple condition, the motion of the spine in the sagittal plane is calculated. From the analysis of sagittal plane motion together with a knowledge of the energy transfer through the intervertebral joint, a new theory of locomotion is derived. This theory of locomotion differs in important respects from current theories, but nevertheless explains available experimental data. This unified theory of the function of the human spine permits the determination of the level of safe loads that can be lifted and transported. It predicts the conditions of load transfer through a joint. It proposes a new approach to the mechanism of arthritis and to the repair of fractures.     

Thoracic spine fractures

Thoracic spine fractures have unique characteristics, and should be managed with specific criteria that are different from those used for thoracolumbar injuries. Fracture-dislocation injuries require high-energy injury, and should always be suspected in polytrauma patients with rib cage, sternum, cardiac, or pulmonary injuries. Although treatment is individualized, multisegmental posterior fixation sometimes combined with anterior decompression, is most commonly used. The authors review the current literature on this topic, and present their opinion on the management of such injuries.     

Imaging the spine

The spine can be assessed using different imaging modalities, each offering their own advantages and limitations. The decision to use a certain type of imaging should be based on a number of factors which include the clinical question to be answered, the speed that answer is needed, the availability of an imaging modality and patient compatibility. We aim to discuss how to best use imaging when investigating spinal pathologies, consider the advantages and limitations of each imaging modality and demonstrate annotated examples of pathology on imaging.