螺旋CT诊断腰椎间盘突出症并发椎管狭窄45例分析

目的探讨螺旋CT对腰椎间盘突出症并发椎管狭窄的诊断价值。方法对2008年1月～2009年3月期间CT诊断为腰椎盘突出症并发椎管狭窄的45例患者的CT资料进行回顾性分析。结果 5例硬膜囊脂肪层消失或不对称,硬膜囊受压变形,神经根被推压移位;4例腰椎间盘后缘弧形突出,位于椎体后缘的中央;13例并发黄韧带肥厚（6～8mm）,5例黄韧带肥厚且伴有钙化,18例均见增厚的黄韧带压迫硬膜囊或神经根使之变形或移位;侧隐窝狭窄9例;椎间孔狭窄者4例。结论螺旋CT可准确显示腰椎小关节突增生肥大、椎间盘突出及椎管狭窄,窗宽、宽位的调整对提高CT诊断准确率具有重要意义。     

胫后神经体感诱发电位对脊髓病变的定位诊断

目的：研究胫后神经体感诱发电位（ＳＥＰ）对脊髓病变的定位诊断价值。方法：电刺激胫后神经，于腰椎、胸椎、颈椎和头皮置记录电极，依次记录ＣＥ，Ｎ２４，Ｎ２８和Ｐ４０电位峰潜伏期。共检测１５例对照组和２９例经磁共振（ＭＲＩ）证实的腰骶神经根或脊髓病变患者。结果：（１）ＣＥ，Ｎ２４，Ｎ２８和Ｐ４０电位均异常，见于腰骶神经根病变。（２）ＣＥ正常，Ｎ２４，Ｎ２８和Ｐ４０异常，或Ｎ２４异常，余电位均正常，见于腰骶髓病变。（３）ＣＥ，Ｎ２４正常，Ｎ２８和Ｐ４０异常，见于胸髓病变。（４）ＣＥ，Ｎ２４，Ｎ２８正常，Ｐ４０异常，见于第６颈椎以上病变。结论：胫后神经ＳＥＰ临床上具有定位诊断价值     

一期后路固定加侧前路病灶清除椎体间植骨治疗胸椎结核

目的探讨一期后路固定加侧前路病灶清除椎体间植骨治疗胸椎结核的临床疗效。方法对27例胸椎结核患者,术前应用异胭肼、利福平、吡嗪酰胺、链霉素等抗结核治疗2～4周,采用一期后路椎弓根系统内固定加侧前路病灶清除椎体间植骨融合手术治疗。结果术后随访6—18个月,平均12个月,切口均一期愈合。椎体间植骨3—6个月融合,平均4个月。无一例复发,后凸畸形矫正满意。结论一期后路固定加侧前路病灶清除椎体间植骨融合治疗胸椎结核有利于恢复脊柱的稳定性,彻底减压脊髓压迫,提高植骨融合率,矫正和预防后凸畸形。     

Analysis of the clinical character of lower thoracic spinal stenosis and safety of the surgery

Objective To observe the pathogenesis, pathology, clinical characters and treatment of the lower thoracic spinal stenosis. Methods From June 1986 to September 2005,37 cases of lower thoracic spinal stenosis were treated surgically. There were 21 males and 16 females with an average age of 56 years. Among the patients, there were 29 cases ligament ossification, which includes OFL 16 cases, OPLL 13 cases;[第一段]     

保留棘突-韧带复合结构手术配合中药辨证治疗腰椎管狭窄症临床疗效观察

目的观察保留棘突-韧带减压手术配合中药辨证治疗腰椎管狭窄症的临床价值。方法 2008年6月~2010年1月间将符合腰椎管狭窄症临床诊断标准且具有手术适应证的60例病人随机分为两组,治疗组采用保留棘突-韧带复合结构椎板切除减压手术配合中药辨证施治治疗;对照组单纯采用保留棘突-韧带复合结构椎板切除减压手术治疗。两组疗效评定采用美国脊柱外科学会的腰椎功能障碍指数(ODI)评估患者的ODI指数并进行分析。结果两组临床疗效比较,治疗组30例,优19例,良8例,可2例,差1例,优良率为90.0%;对照组30例,优18例,良7例,可3例,差2例,优良率为83.3%;两组临床疗效比较差异无统计学意义(P>0.05)。而ODI分数及症状改善率治疗组优于对照组(P<0.05)。结论保留棘突-韧带复合结构椎板切除减压手术配合中药辨证治疗腰椎管狭窄症不失为一种有效的治疗方法之一。     

微创后路椎间盘镜治疗腰椎管狭窄症与腰椎间盘突出症的应用

目的　探讨后路椎间盘镜治疗腰椎管狭窄症与腰椎间盘突出症的临床应用和适应证。方法　采用后路椎间盘镜进行单侧“开窗”减压术与髓核摘除术等。术中通过“C”臂机或摄侧位X线片定位 ,于后正中做1～ 2个长约 1 5cm互不相连的小切口 ,逐级扩张后置入工作通道管 ,钻除部分椎板 ,置入内窥镜 ,于监视器下显露并清除椎板、增生内聚的关节突、肥厚的黄韧带及突出的椎间盘髓核组织 ,彻底解除其对硬膜、神经根的压迫。结果　本组共治疗腰椎管狭窄症 732例 ,随访 3个月～ 3年。按NAKAI标准评定 :优 6 40例 ,良 6 9例 ,可 18例 ,差 5例。优良率为 97%。 3例改行开放式手术治疗。结论　该术式在保证神经充分减压的前提下 ,可减少创伤 ,保持脊柱的稳定性。该方法适用于单节段或多节段腰椎管狭窄症及合并腰椎间盘突出症的患者。     

高压氧及甲基强的松龙联合应用预防脊髓缺血再灌注损伤的疗效观察

目的：探讨颈、胸椎管狭窄症患者围手术期应用高压氧疗法、甲基强的松龙对脊髓缺血再灌注损伤的疗效。方法：对46例行颈、胸椎后路椎板减压治疗的颈、胸椎管狭窄症患者在术前、术后应用高压氧、甲基强的松龙治疗。结果：高压氧疗法与甲基强的松龙联合应用能有效缓解或消除脊髓缺血再灌注损伤的症状。结论：高压氧疗法、甲基强的松龙是治疗脊髓缺血再灌注损伤的理想方法。     

胸腰椎结核后路病灶清除一期植骨融合内固定术的疗效分析

目的 探讨后路病灶清除一期内固定治疗胸腰椎结核的临床疗效.方法 对1999年1月至2008年9月间55例脊柱结核患者采用病灶清除、TRSH固定,男29例,女26例,年龄20～77岁,平均39岁.病变节段胸椎30例,腰椎27例.胸腰联合4例.所有患者均有不同程度的后凸畸形,Cobb角(40±3)°,10例伴有不完全截瘫.Frank A级1例,B级7例,C级17例.所有患者术前4-8周的正规的抗结核治疗.结果 术后55例均获得随诊,术后随访0.5～9年,平均2年,术后有1例患者术后出现切口窦道,扩创后愈合.并发急性肺不张1例,经对症处理愈合.结论 经后路病灶清除一期内固定治疗脊柱结核可以很好地清除病灶,脊髓及神经根减压、植骨融合稳定,矫正畸形,提高脊柱结核的治愈率.     

Intraoperative ultrasonography in “cave-in” 360° circumferential decompression for thoracic spinal stenosis

Background  The surgical outcomes of decompression for thoracic spinal stenosis (TSS) are unfavorable. The purpose of this study was to determine the efficacy of intraoperative ultrasonography during “cave-in” 360° circumferential decompression surgery in patients with TSS.

Methods  Thirteen patients with TSS underwent “cave-in” 360° circumferential decompression surgery between May 2010 and November 2010. Intraoperative ultrasonography was used after removal of the posterior wall of thoracic spinal canal to assess the morphologic restoration of the spinal cord and the anterior surface of the spinal canal. In seven patients, ultrasonography was used again after circumferential decompression to compare the cross-sectional area of the spinal cord before and after circumferential decompression.

Results  The average period of follow-up was (12±2) months (range 9–15 months). The Japanese Orthopedic Association score was significantly higher at the final follow-up (8.5±2.1, range 3–10) than preoperatively (5.2±1.1, range 3–7; P <0.01). The cross-sectional area of the spinal cord was (30.8±6.6) mm² before and (53.6±19.1) mm² after circumferential decompression (P <0.01). For five patients with TSS caused by thoracic disc herniation, the levels of circumferential decompression performed corresponded to those expected preoperatively. In contrast, for eight patients with TSS caused by ossification of the posterior longitudinal ligament, on average 1.6±0.9 fewer levels of circumferential decompression were performed than expected preoperatively.

Conclusions  “Cave-in” 360° circumferential decompression is an effective therapeutic option for TSS. Intraoperative ultrasonographic evaluation may reduce the levels of circumferential decompression and ensure sufficient decompression, and increase the efficacy of this surgical technique.

     

6例损伤性枢椎滑脱临床报告

报告６例损伤性框椎滑脱病例,按Ｌｅｖｉｎｅ分类：Ⅰ型２例,Ⅱ型３例,Ⅲ型１例,均无严重的脊髓损伤。２例手术处理,１例后路椎板植骨融合,１例前路椎间植骨融合。４例经非手术治疗骨折愈合,预后好。认为损伤性枢椎滑脱主要是上颈椎伸展和压缩外力所造成枢椎椎弓在原始外力作用下骨折,前纵韧带受牵张或颈３椎体前缘撕脱骨折,但此韧带仍完整,随即回弹屈曲使后纵韧带与椎间盘结构破裂,而致枢椎滑脱。     

老年退变性腰椎侧凸合并腰椎管狭窄的手术疗效

目的探讨手术治疗老年退变性腰椎侧凸合并腰椎管狭窄的临床疗效。方法回顾性分析本院从2004年1月至2008年1月收治的退变性腰椎侧凸合并腰椎管狭窄患者37例,包括男性15例,女性22例,年龄(57.6±5.8)岁,比较患者手术前后及末次随访时的Cobb角、ODI功能评分。结果本组病例都获得了临床随访,随访(18.5±5.5)个月,患者术后临床症状明显改善,自诉生活质量明显提高;术前ODI功能评分(59.6±12.5)分,术后(34.6±8.6)分,差异有统计学意义(P<0.05),末次随访时评分(36.3±6.8)分,与术前比较差异有统计学意义(P<0.05);Cobb角由术前(25.3±5.7)°矫正至术后(11.4±6.3)°,改善率平均为84.5%;骨融合率达到100%,无椎间融合器移位、椎间隙塌陷、断钉断棒等发生。结论后路减压结合椎弓根螺钉固定融合矫形术是治疗退变性腰椎侧凸合并腰椎管狭窄的有效方法之一。     

椎板复合结构瓣回植治疗腰椎间盘突出症长期随访报告

目的探讨椎板复合结构瓣回植术式治疗腰椎间盘突出症的远期临床疗效。方法应用椎板复合结构瓣回植术式治疗腰椎间盘突出症176例,男117例,女59例,年龄18～79岁。合并中央椎管狭窄者32例,侧隐窝狭窄者57例。结果随访5～10年,平均7年。优143例,良27例,可6例。结论本术式显露范围广、椎管减压彻底,使椎管重新成形,有效的预防术后脊柱不稳、顽固性腰痛等并发症。     

伤椎置钉 GSS 系统治疗胸腰段脊柱骨折临床观察

目的：探讨伤椎置钉GSS系统治疗胸腰段脊柱骨折患者的临床应用和疗效。方法：选取2010年1月-2011年6月本院收治的胸腰段脊柱骨折患者50例,所有患者均伴有不同程度的脊柱神经损伤,其中根据Frankel分级标准：A级4例,B级4例,C级20例,D级15例,E级7例。对所有患者均应用GSS系统加伤椎置钉的方法进行治疗,并对疗效进行观察。结果：50例患者手术均成功,随访18个月,所有患者骨折均恢复良好,无切口感染和脊髓损伤等并发症发生;所有患者的椎体前后缘高度与术前相比均有明显提高（P〈0.05）;Cobb角与术前相比也有明显缩小（P〈0.05）;除2例脊髓神经损伤为A级的患者以外,其余患者的脊髓神经损伤均有1-3级的恢复。结论：应用GSS系统加伤椎置钉的方法治疗胸腰段脊柱骨折患者疗效确切,且能明显改善患者的临床症状,增加术后的稳定性,值得临床推广。     

颈椎后纵韧带骨化症的治疗进展

颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)是指异位骨化的后纵韧带对椎管内脊髓和神经根产生压迫而表现出脊髓损害及神经根刺激的症状。该病首先由日本学者报道,逐渐受到全世界学者的广泛关注,发现其多发于东亚地区,欧美发病率较低。同时对其发病机制和诊断治疗策略进行了一系列的研究。本文就颈椎0PLL的治疗进展做一综述。     

手术治疗颈脊髓受压型疾病65例分析

目的探讨颈脊髓受压型疾病的手术治疗方法。方法对北京市延庆县医院骨科自2003年8月至2008年11月收治的30例颈脊髓受压型病人及北京积水潭医院脊柱外科2008年12月至2009年9月收治的35例颈脊髓受压型患者行不同术式的手术治疗:颈前路减压30例,颈后路减压30例,前后路一期联合手术5例。按JOA评价临床疗效。结果 65例患者均得到9个月至5年门诊或电话随访,均获得满意疗效。结论伴有发育性颈椎管狭窄者、颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)者、退变性椎管狭窄者,选择颈后路椎管扩大成形术;1～2个椎间盘突出者选择颈前路减压植骨融合钛板内固定术或行颈椎人工间盘置换术;椎管狭窄合并椎间盘突出较大脊髓前后受压者,可选择一期前后路联合手术。     

胸腰椎爆裂骨折几种入路的对比研究

目的:评价不同的手术入路治疗胸腰椎爆裂骨折的优缺点。方法:采用三种不同的手术入路治疗腰椎爆裂骨折46例,其中经后路32例,前路10例,前后联合入路4例。采用ASIA标准评定神经功能恢复情况,通过影像学检查比较伤椎和Cobb角的矫正及丢失,评估椎管减压范围、植骨块位置及愈合情况。结果:46例随访8～36个月,平均13个月,术前不完全性损伤的40例患者神经功能恢复1级或1级以上。脊髓神经功能术前为A级6例,术后均无恢复。结论:胸腰椎爆裂骨折术式的选择取决于脊柱稳定性、神经损伤情况以及椎管内占位程度。     

腰椎管狭窄症的CT诊断

目的：探讨CT对腰椎管狭窄症的诊断价值。方法：对100例腰椎管狭窄症患者的CT扫描结果进行分析。结果：100例腰椎管狭窄症患者的CT主要表现为椎间盘膨出或突出，椎体小关节增生、内聚，椎体骨赘，黄韧带肥厚、钙化，椎板增厚，椎弓根发育不良，后纵韧带肥厚、钙化、骨化等多种病理变化。结论：CT可以清楚的显示腰椎管狭窄的各种组织病理变化，诊断符合率高，并对分类有指导意义。     

SURGICAL TREATMENT OF SCOLIOSIS CAUSED BY NEUROFIBROMATOSIS TYPE 1

Objective To retrospectively analyze the relationship between curve types and clinical results in surgical treatment of scoliosis in patients with neurofibromatosis type 1 (NF-1).Methods Forty-five patients with scoliosis resulting from NF-1 were treated surgically from 1984 to 2002. Mean age at operation was 14.2 years. There were 6 nondystrophic curves and 39 dystrophic curves depended on their radiographic features. According to their apical vertebrae location, the dystrophic curves were divided into three subgroups: thoracic curve (apical vertebra at T8 or above), thoracolumbar curve (apical vertebra below T8 and above L1), and lumber curve (apical vertebra at L1 and below). Posterior spine fusion, combined anterior and posterior spine fusion were administrated based on the type and location of the curves. Mean follow-up was 6.8 years. Clinical and radiological manifestations were investigated and results were assessed.Results Three patients with muscle weakness of low extremities recovered entirely. Two patients with dystrophic lumbar curve maintained their low back pain the same as preoperatively. The mean coronal and sagittal Cobb′s angle in nondystrophic curves was 80.3° and 61.7° before operation, 30.7° and 36.9° after operation, and 32.9° and 42.1° at follow-up,respectively. In dystrophic thoracic curves, preoperative Cobb's angle in coronal and sagittal plane was 96.5° and 79.8°,postoperative 49.3°and 41.7°, follow-up 54.1° and 45.3°, respectively. In thoracolumbar curves, preoperative Cobb's angle in coronal and sagittal plane was 75.0° and 47.5°, postoperative 31.2° and 22.8°, follow-up 37.5° and 27.8°, respectively. In lumbar curves preoperative Cobb's angle in coronal plane was 55.3°, postoperative 19.3°, and follow-up 32.1 °. Six patients with dystrophic curves had his or her curve deteriorated more than 10 degrees at follow-up. Three of them were in the thoracic subgroup and their kyphosis was larger than 95 degrees, and three in lumbar subgroup. Hardware failure occurred in 3cases. Six patients had 7 revision procedures totally.Conclusions Posterior spinal fusion is effective for most dystrophic thoracic curves in patients whose kyphosis is less than 95 degrees. Combined anterior and posterior spinal fusion is stronger recommended for patients whose kyphosis is larger than 95 degrees and those whose apical vertebra is located below T8. Patients should be informed that repeated spine fusion might be necessary even after combined anterior and posterior spine fusion.     

胸腰椎爆裂性骨折的X线平片和CT诊断价值

目的探讨胸腰椎爆裂性骨折在X线平片和CT片中的诊断价值。方法时50例急性胸腰椎外伤患者的X线平片和CT表现特点进行回顾性分析，其中胸椎13例。腰椎35例，胸腰椎2例；外伤后全部拍摄X线正侧位片及CT平扫，其中7例行CT冠矢状位重建。结果50例急性脊柱外伤中X线平片清楚显示椎体骨折32例34个椎体为爆裂性骨折，CT清楚显示椎体骨折50例54个椎体骨折（48个椎体为爆裂性骨折），附件骨折13例，小关节脱位1例，见到骨折片突向椎管内22例，椎管内高密度血肿3例，脊髓或神经受压22例。结论X线平片对胸腰椎爆裂性骨折的诊断有一定价值．CT在显示脊柱三柱结构、附件骨折、椎管狭窄、椎间盘突出、脊髓及神经根损伤等细节方面优于X线平片。     

一期后路椎体次全切除，钛网重建联合经伤椎椎弓根钉内固定治疗严重多节段胸腰椎骨折临床观察

Objective:To evaluate clinical effects of subtotal corpectomy and three column stabilization combined with pedicle screw including the fracture vertebra through posterior approach on severe multilevel thoracic and lumbar fractures . Methods:Eleven cases of severe multilevel thoracic and lumbar fractures were treated by subtotal corpectomy and three column stabilization combined with pedicle screw including the fracture vertebra through posterior approach. The reduction, height of the fractured vertebra, the neurological recovery, the Cobb’s angle and spinal canal compromise were evaluated before and after operation. Results:All the cases were followed up, 5 cases achieved recovery of neurological function in different degrees, and there was no internal fixation failure in all cases , for the height of the fracture vertebra which was not severe was (40.7±5.1)％ before operation (72.7±4.7)％,and the Cobb’s angle was (29.2±6.3)°before operation (9.2±3.1)°. For the severe vertebra Cobb’s angle is (15.6±1.4)°kyphosis before operation,(19.7±2.7)°lordosis after the operation; spinal canal compromise was (81.2±3.2)% before the operation and zero after the operation. Conclusion: This therapeutic method may be an effective treatment for severe multilevel thoracic and lumbar fractures.