颈椎侧弯对颈椎间孔形态的影响

目的:分析侧弯对颈椎间孔形态的影响,并探讨其对临床工作的指导意义。方法:对10名健康志愿者分别于颈椎中立位及侧弯位利用多层螺旋CT进行自C3椎体上缘至C7椎体下缘的横断面扫描,并在C3/4、C4/5、C5/6、C6/7椎间孔斜45°的重建图像上测量椎间孔的上下径、上前后径、下前后径及截面面积,比较侧弯时颈椎间孔形态的变化。结果:侧弯时侧弯侧颈椎间孔截面面积因孔的上下径、上前后径及下前后径的减小而减小13.07%,对侧因孔的上下径、上前后径及下前后径的增大而增大19.84%,C3/4椎间孔面积变化率与C3/C4间侧弯角度存在相关性。结论:侧弯可影响颈椎间孔的形态,且相互间存在有一定的相关性。此结果对颈椎病,尤其是神经根型颈椎病的预防、诊断和治疗有临床指导意义。     

超声引导下颈椎椎间孔注射治疗神经根型颈椎病的临床研究

目的:探讨超声引导下颈椎椎间孔注射治疗神经根型颈椎病的准确性、安全性及有效性.方法:采用前瞻性、随机、双盲、对照研究,选取2017年12月至2018年12月疼痛科就诊符合纳入标准的神经根型颈椎病病人共40例,随机分为CT组(A组)、超声组(B组),每组20例.根据病人神经受累区域确定2个穿刺节段,在CT或超声引导下进行...     

颈椎间孔形态及颈椎间孔狭窄的研究进展

随着我国人均寿命的延长 ,以退行性变为主的颈椎病患者亦随之增加。有调查证明 :5 0岁左右的人群中 ,2 5 %患过或正在患颈椎病 ,至 60岁则达 5 0 % ,而 70岁后患病率几乎为百分之百。颈椎间孔狭窄是颈椎病 (尤其是神经根型颈椎病 )的病因之一 ,亦可导致临床上的各种症状。本文就颈椎间孔形态及颈椎间孔狭窄的研究进展进行综述。颈椎间孔的解剖特点颈椎间孔略呈倒置的泪滴状[1] ,上部较宽 ,下部较窄 ,中部较小。Ｈｕｍｐｈｒｅｙｓ等[2 ] 将其描述为葫芦状。颈椎间孔由上、下相邻的椎弓根 ,后侧的关节柱、黄韧带及前部的椎骨后外侧、椎间盘和…     

透视下定位点片观察颈椎间孔的临床应用

颈椎病是一种常见病、多发病，通常分为五型，以神经根或以其为主的混合型最为为见，而椎间孔是神经根的唯一通道，如何显示椎间孔及其周围的骨质结构，对颈椎病的诊断是十分重要的。我院近2年来通过对150例临床拟诊为颈椎病患者采用旋转脚踏板行颈椎斜位透视下定位点片，对椎间孔周围骨质结构的显示及观察收到良好的效果，现介绍如下。     

颈椎椎间孔大小与脊神经根型颈椎病的关系研究

神经根型颈椎病在颈椎病各型中发病率最高,椎间孔狭窄压迫脊神经根是引起本病的主要原因,而引起颈椎间孔狭窄的因素很多.本文就颈椎椎间孔的解剖、在X线上的投影及影响其大小的因素予以综述.     

颈椎旋转错位影像与矢量正椎复位治疗分析

对比分析不同复位方法对颈椎旋转错位治疗的效果。以收治的颈椎垂直旋转错位患者120例作为研究对象,采用随机数字表法分为对照组和观察组各60例,观察组接受矢量正椎复位治疗,对照组接受常规手法复位治疗。对比两种不同复位方法的治疗效果。观察组总有效率达95.00%,对照组为75.00%,差异显著,具有统计学意义(P0.05)。矢量正椎复位对颈椎旋转错位治疗效果明显优于常规复位治疗,值得临床推广使用。     

旋转复位与牵引治疗神经根型颈椎病的随机对照疗效分析

目的：探讨旋转复位手法治疗神经根型颈椎病的效果。方法：选择100例神经根型颈椎病患者，随机分为手法组和牵引组，两组均加物理因子治疗(超短波和电脑中频)。治疗4周及8周后评定疗效。结果：在4周后手法组有效43例，总有效率为86．0％；牵引组有效29例，总有效率为58．0％，两组差异有显著性意义(χ^2=5．49，P&;lt;0．05)；在8周后手法组总显效例数42例，总显效率为84．0％；牵引组总显效例数27例，总显效率54．0％，两组差异有显著性意义(χ^2=5．79，P&;lt;0．05)，说明手法组有效率较牵引组高。结论：旋转复位手法较颈椎牵引疗效佳。     

左右侧弯载荷对椎间孔孔径的影响

背景:国内外尚未见运用Bryan颈人工椎间盘置换后对邻近节段(包括邻近一个及两个节段)椎间孔形态改变的研究.目的:分析椎间盘完整、椎间盘切除、Bryan颈人工椎间盘置换和前路颈椎植骨融合钢板内固定后,成人尸体颈椎标本分别在左右侧弯载荷下C5/6椎间孔孔径和面积的变化情况.设计、时间及地点:体外对比观察,生物力学测定实验,于2006-01102在中南大学材料科学与工程学院国家重点实验室完成.材料:取新鲜人体厂1体颈椎标本10具,节段包括C3～T1,剔除肌肉组织保留椎间盘、韧带和关节囊结构的完整.方法:在实验机上分别测量C5/6椎间盘完整、椎间盘髓核摘除、Bryan颈人工椎间盘置换和前路钢板植骨内固定4种状态下以0.25,0.5,0.75,1.00,1.25,1.5 N·m的分级载荷加载十标本在侧弯状态时C5/6椎间孔孔径和面积的变化情况.主要观察指标:C5/6椎间孔孔径与面积.结果:侧弯各级加载时,椎间盘完整组、Bryan颈人工椎间盘置换组和前路钢板植骨内固定组的cs,6椎问孔上下径、上前后径、下前后径和面积高于椎间盘髓核摘除组,差异有显著性意义(P<0.05),Bryan颈人工椎间盘置换组高于前路钢板植骨内固定组,差异有显著性意义(P<0.05).其余各组比较,差异无显著性意义(P>0.05).结论:颈椎间盘髓核摘除后CUb椎间孔有效空问明显减少,Bryan颈人工椎间盘置换较前路钢板植骨内固定更有助于椎间孔孔径和面移{的恢复.     

颈前路多椎间孔间隙显微减压术对颈椎稳定性的生物力学评价

目的：从生物力学角度评价多椎间孔间隙单侧钩突切除术对颈椎稳定性的影响。方法：6例成人新鲜颈椎标本，选择C4-7为实验节段。按正常组，手术组，在2N&;#183;m纯力偶作用下分别产生前屈、后伸，左/右侧弯和左/右侧旋运动，通过脊柱三维运动测试来比较两种手术方式对颈椎稳定性的影响。结果：①在6个运动方向上，手术组术后ROM较术前无明显增加（P&;gt;0.05,t前屈=-1.932,t后屈=-1.447,t右弯=-2.768,t左旋=-1.743,t右旋=-1.753)，差异无显著性。②运动范围的总和，手术组较术前有明显增加，差异具有非常显著性（P&;lt;0.01,F=17.448)结论：前路多椎间孔间隙显微减压术对颈椎静态稳定性的影响较小，主要表现在颈椎运动范围总和的增加，对某一方向三维运动范围的影响不明显。     

Observation and measurement of applied anatomical features for thoracic intervertebral foramen puncture on computed tomography images

BACKGROUNDThoracic intervertebral foramen puncture is the key step for interventional therapy on the thoracic nerve roots or dorsal root ganglia. The anatomical features of the thoracic spine are complex, and puncture injury to the pleura, blood vessels, spinal cord, and other tissues may cause serious complications. The spatial anatomical characteristics and related parameters for thoracic intervertebral foramen puncture remain poorly understood.AIMTo observe and summarize the spatially applied anatomical characteristics for intervertebral foramen puncture on different vertebral segments.METHODSA total of 88 patients (41 males and 47 females) who underwent thoracic minimally invasive interventional treatment at Nanjing Drum Tower Hospital from January 2019 to June 2020 were included. Computed tomography images of 167 thoracic vertebral segments scanned in the prone position were collected. The width of the intertransverse space (D_P), the height of the rib neck/head above the lower transverse process (D_R), the width of the lateral border of the articular process/lamina (W_P), and the width of the posterior border of the vertebral body (W_V) were measured. At the upper 1/3 of the intervertebral foramina, the horizontal inclination angle (α) from the lateral border of the articular process/lamina to the posterolateral border of the vertebral body was measured. The ratios D_R/D_P and W_P/W_V were calculated. The intervertebral foramen parameters were compared between segments.RESULTSNo rib head/neck occlusion (D_R/D_P > 0) was found in the intertransverse spaces of T1-2 and T12-L1. The incidence of occlusion for the upper thoracic segments (T1-5, n = 138), middle thoracic segments (T5-9, n = 116), and lower thoracic segments (T9-L1, n = 80) were 76.81%, 100%, and 82.50%, respectively. The incidence of occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments (P < 0.05). The incidence of > 1/2 occlusion (D_R/D_P > 1/2) for the upper, middle, and lower thoracic segments was 7.97%, 74.14%, and 32.50%, respectively. The incidence of > 1/2 occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments (P < 0.05). W_P was longer than W_V on T1-2 to T9-10 and shorter than W_V on T10-11 to T12-L1. The horizontal puncture angle (α) into the external opening of the intervertebral foramina was positively correlated with the segments of the thoracic vertebrae from the cephalic to caudal portion (left: r = 0.772, P < 0.01; right: r = 0.771, P < 0.01), and the horizontal inclination angle for T11-12 and T12-L1 was 90°.CONCLUSIONIt is necessary to identify the spatial impact of the rib head/neck on the puncture path of the intervertebral foramina and design appropriate puncture angles for different segments.     

Lower lumbar spine axial rotation is reduced in end-range sagittal postures when compared to a neutral spine posture

Sports such as rowing, gymnastics, cycling and fast bowling in cricket that combine rotation with spine flexion and extension are known to carry greater risk of low back pain (LBP). Few studies have investigated the capacity of the lumbar spine to rotate in various sagittal positions, and further, these studies have generated disparate conclusions. The purpose of this study was to determine whether the range of lower lumbar axial rotation (L3–S2) is decreased in end-range flexion and extension postures when compared to the neutral spine posture. Eighteen adolescent female rowers (mean age=14.9 years) with no history of LBP were recruited for this study. Lower lumbar axial rotation was measured by an electromagnetic tracking system (3-Space Fastrak™) in end-range flexion, extension and neutral postures, in sitting and standing positions. There was a reduction in the range of lower lumbar axial rotation in both end-range extension and flexion (p<0.001) postures when compared to neutral. Further, the range of lower lumbar axial rotation measurements in flexion when sitting was reduced when compared to standing (p=0.013). These findings are likely due to the anatomical limitations of the passive structures in end-range sagittal postures.     

64层螺旋CT颈椎外伤低剂量扫描

目的：比较64层螺旋CT颈椎采集模式和盆腔采集模式的扫描剂量。材料和方法：选用60例颈椎外伤的患者进行64层螺旋CT检查扫描,并使用水模对比扫描。患者扫描范围180 mm：30例行颈椎模式,30例行盆腔模式;水模扫描范围 30 mm,分别使用两种模式扫描30次。记录患者和水模每次扫描的平均容积剂量指数（CTDIvol）、扫描时间和有效球管电流数值,并计算出剂量长度和平均有效剂量。3名有资质医师双盲法对两组图像质量评分。结果：患者盆腔模式组平均容积剂量<颈椎模式组,盆腔模式组平均有效剂量比颈椎模式组降低59.0%。两组图像质量差异无统计学意义（P>0.05）, 均满足临床要求。水模对比结果相同。结论：64层螺旋CT盆腔模式适合颈椎扫描,辐射剂量小。     

上颈椎椎间旋转活动在体三维测量与分析

目的:探讨对人体上颈椎椎间旋转活动度及其耦合运动进行精确测量的方法。方法:对16名健康志愿者行颈椎三维CT扫描,并行三维重建,应用自行设计的计算机软件程序对三维图像标点,并利用标志点测量上颈椎包括枕骨与寰椎之间,寰椎与枢椎之间的椎间旋转及耦合运动。结果:颈椎最大旋转位时,单侧椎间平均旋转度分别为枕骨-寰椎(2.4±1.8)°,寰椎-枢椎(38.5±4.7)°,同时伴随各节段的反向侧屈与后伸活动;侧屈动度分别为枕骨-寰椎(3.6±1.3)°,寰椎-枢椎(5.4±2.0)°,后伸动度分别为枕骨-寰椎(12.9±3.8)°,寰椎-枢椎(4.9±2.6)°。结论:可运用三维CT图像对在体上颈椎椎间旋转及耦合运动进行精确的测量,其有助于上颈椎在三维空间内的复杂运动更进一步理解,更好地为上颈椎疾病的诊治提供解剖基础。     

小肠间质瘤的多层螺旋CT诊断

目的：探讨小肠间质瘤的多层螺旋CT（MSCT）表现和特征。方法：35例经手术和病理证实的小肠间质瘤病例,对其CT增强前后影像资料进行回顾性分析。结果：35例经病理证实的小肠间质瘤病例中,恶性间质瘤20例,潜在恶性15例。间质瘤位于十二指肠7例,空肠16例,回肠12例,所有间质瘤均经CT检查检出。肿瘤最大径从1.5cm至16.7cm,平均为5.5cm。肿瘤大多边界清晰,以向腔外生长为主,肿瘤增强后可出现比较明显的强化。肿瘤边界清晰的占全部病例的91.4%（32/35）,肿瘤以腔外生长为主的占80%（28/35）,肿瘤出现中度强化以上的占94.3%（33/35）。结论：小肠间质瘤的CT表现具有一定的特征,MSCT检查对于检出肿瘤和明确部位,治疗前的综合评估以及治疗后的跟踪随访均具有重要意义。     

应用CT轴位扫描降低腰椎间盘病变放射辐射剂量的研究

目的探讨CT轴位扫描应用于腰椎间盘扫描以降低辐射剂量的可行性及其临床应用价值。方法随机抽取正常BMI的60例志愿者行CT腰椎间盘检查,在其他参数均相同情况下分别进行常规剂量(270 mA)和低剂量(180 mA、135 mA)扫描,比较两种不同低剂量CT扫描所得图像与常规剂量的图像质量差异,以及发现椎间盘病变的差异。结果在扫描图像质量方面,两种不同低剂量与常规剂量扫描有统计学差异(P<0.05)。但在诊断疾病方面,两种不同低剂量扫描与常规剂量扫描无统计学差异(P>0.05)。在满足诊断需要的同时,患者接受的辐射剂量分别降低36.5%及54.0%。结论轴位扫描应用于腰椎间盘CT扫描具有一定的可行性,并可大幅度降低患者辐射剂量。     

Multiple muscle force simulation in axial rotation of the cervical spine

OBJECTIVE: To produce axial rotation of the cervical spine in vitro by coordinated application of eight simulated muscle forces. DESIGN: Biomechanical testing of the cervical spine by controlled pneumatics. BACKGROUND: Some muscle simulation experiments have been performed in vitro in the lumbar spine but data generally are lacking for this testing mode in the cervical spine. Thus, physiological biomechanical behavior in this region remains poorly understood. METHODS: Six human donor cervical spines were loaded by a set of computer-controlled pneumatic cylinders representing pairs of trapezius, splenius and sternocleiodmastoid muscles, plus longus and splenius colli left. Muscle functions were derived from a previously-developed mathematical optimization model. Muscle forces generally were achievable within 2 N of the intended values provided by the model. RESULTS: Rotation of the head followed fairly closely that predicted by the model. The resulting force components to produce 37 degrees were dominated by axial compression of about--100 N and the resulting moments were similar in all planes at about 2 Nm. Coupled motions were larger than primary motions in some intersegmental behavior. CONCLUSIONS: Slow, physiologic axial rotation of the head may be simulated by a complex and representative series of controlled pneumatics. Controlled rotation results in a relatively high compressive force and occurs through fairly balanced and small moments. RELEVANCE: Experimental approaches in biomechanics are generally limited to one or two simplified muscle forces whose representation of in vivo loading conditions can only be presumed. Improvements in the application of pneumatic technology are a promising approach to more thoroughly duplicating the physiological loading environment.     

腰椎间盘突出症的影像学诊断

目的：比较各种影像学检查对腰椎间盘突出症诊断的优缺点。材料与方法：选取经手术证实且全部具有X线平片、cT、MRI、椎间盘造影后cT(cTD)、脊髓造影后cT(cTM)检查的腰椎间盘突出症患者29例，共有38个间盘行间盘造影，34个间盘经手术证实。结果：在34个经手术证实的间盘中，28个为侧后方突出，5个为后正中突出，1个为侧方突出。结论：MRI诊断的敏感性及特异性较脊髓造影及cTM高，间盘造影及cTD可以精确地反映椎间盘的病理学改变。     

MSCT与高频超声结合对项韧带退变与颈椎退变相关性研究

目的：研究项韧带退变与颈椎退变的关系。方法：病例组65例,对照组58例,两组均进行中立位MSCT颈部容积扫描,中立位与45°前伸位项韧带高频超声扫描,观察项韧带形态、密度、最小横截面积变化率,将两组观察结果与相关测量数据进行对比分析。结果：病例组项韧带33.85%失去原有三棱状外形,38.46%项韧带索状部扭曲,27.69%项韧带索状部出现钙化。病例组与对照组比较,病例组Ⅰ～Ⅳ段项韧带索状部增粗、膜状部增厚,整体密度增高,两组间差异均有统计学意义（P<0.05）。两组间索状部最小横截面积变化率对比,病理组Ⅰ、Ⅱ、Ⅳ段减小,Ⅲ段增大,两组间差异有统计学意义（P<0.05）。结论：项韧带退变与颈椎退变及颈椎病的发生密切相关,其形态、密度、最小横截面积变化率的异常改变同项韧带钙化一样,也是颈椎退变重要的影像表现,提高对此类影像表现的认知,对颈椎病的影像诊断和临床相关治疗工作有重要的意义。