颈椎旋转对颈椎间孔形态的影响

目的　分析旋转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旋转位利用多层螺旋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 ,比较旋转时颈椎间孔形态的变化。结果　旋转时旋转侧颈椎间孔截面面积减小 ,对侧椎间孔截面面积增大 ,C3～ 4椎间孔面积变化率与C3 、C4间旋转角度亦存在相关性。结论　旋转可影响颈椎间孔的形态 ,且其相互间存在一定的相关性。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。     

前屈后伸载荷下颈椎间孔的孔径变化:Bryan颈人工椎间盘置换与颈椎钢板植骨内固定的比较

背景:诸多针对脊椎椎体间固定融合后相邻节段应力变化的生物力学测试结果并不尽相同,载荷控制与位移控制试验模式下所反映出的相邻节段应力状况其结果也相差甚远.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前屈后伸载荷下C5/6椎间孔孔径和面积的变化情况.方法: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0.25,0.50,0.75,1.00,1.25,1.50 N·m的分级载荷加载于标本的前屈后伸状态时C5/6椎间孔孔径和面积的变化情况.结果与结论:前屈后伸各级加载时,C5/6椎间孔上下径、上前后径、下前后径和面积椎间盘完整组、Bryan颈人工置换组和钢板植骨内固定组高于椎间盘髓核摘除组,差异有显著性意义(P<0.05),Bryan颈人工置换组高于钢板植骨内固定组,差异有显著性意义(P<0.05),可见颈椎间盘髓核摘除后C5/6椎间孔有效空间明显减少.     

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.     

颈神经在颈椎间孔及脊神经沟处受嵌压的解剖学因素

背景神经根型颈椎病中神经根能否受累,不仅与所在骨管是否狭窄、周围软组织是否存在炎性病变和肿胀有关,还与神经根外径的相对大小有关.目的通过颈神经在颈椎间孔及脊神经沟处受累的出现率,探讨神经根型颈椎病发生的解剖学因素.设计单一样本观察.单位承德医学院解剖研究室.对象甲醛固定成尸60具(男28,女32)120侧.方法在60具成尸上,用精确度0.02 mm的游标卡尺和直角规测量①脊神经沟外口宽度及其沟内段脊神经前支横径.②颈椎间孔及其脊神经根的前后径、上下径.计算颈神经前支横径与相应颈椎脊神经沟外口宽度的比值和脊神经根前后径、上下径与相应椎间孔前后径、上下径的比值.得出颈神经前支横径大于或等于脊神经沟外口宽度的出现率和脊神经根各径线大于或等于相应椎间孔各径线的出现率.主要观察指标①C3～6颈神经前支横径大于或等于相应脊神经沟外口宽度的出现率.②C3～6颈神经根上下径、前后径分别大于或等于相应颈椎间孔上下径、前后径的出现率.结果共测量成尸60具120侧(男56侧,女64侧).①颈神经根在椎间孔处可造成嵌压男女合计总出现率为24.6%其中女性明显高于男性(35.2%,10.9%,x2=6.72,P＜0.01).②颈神经前支在颈椎脊神经沟处可造成嵌压男女总出现率为6.3%,其中男性明显高于女性(8.9%,3.9%,x2=6.65,P＜0.01).结论颈神经受累不仅与骨管狭窄有关,而且与周围软组织损伤有关,通过神经根外径与椎间孔的比值和颈神经前支与脊神经沟外口宽度比值,选其≥1的出现率可直接获得神经受压的出现率.     

颈神经在颈椎间孔及脊神经沟处受嵌压的解剖学因素

背景：神经根型颈椎病中神经根能否受累，不仅与所在骨管是否狭窄、周围软组织是否存在炎性病变和肿胀有关，还与神经根外径的相对大小有关。目的：通过颈神经在颈椎间孔及脊神经沟处受累的出现率，探讨神经根型颈椎病发生的解剖学因素。设计：单一样本观察。单位：承德医学院解剖研究室。对象：甲醛固定成尸60具(男28，女32)120侧。方法：在60具成尸上，用精确度0．02mm的游标卡尺和直角规测量：①脊神经沟外口宽度及其沟内段脊神经前支横径。②颈椎间孔及其脊神经根的前后径、上下径。计算颈神经前支横径与相应颈椎脊神经沟外口宽度的比值和脊神经根前后径、上下径与相应椎间孔前后径、上下径的比值。得出颈神经前支横径大于或等于脊神经沟外口宽度的出现率和脊神经根各径线大于或等于相应椎间孔各径线的出现率。主要观察指标：①C3-6经前支横径大于或等于相应脊神经沟外口宽度的出现率。②C3-6上下径、前后径分别大于或等于相应颈椎间孔上下径、前后径的出现率。结果：共测量成尸60具120侧(男56侧，女64侧)。①颈神经根在椎间孔处可造成嵌压男女合计总出现率为24．6％其中女性明显高于男性(35．2％，10．9％，X^=6.272，P&;lt;0．01)。②颈神经前支在颈椎脊神经沟处可造成嵌压男女总出现率为6．3％，其中男性明显高于女性(8．9％，3．9％，X^=6．65，P＜0．01)。结论：颈神经受累不仅与骨管狭窄有关，而且与周围软组织损伤有关，通过神经根外径与椎间孔的比值和颈神经前支与脊神经沟外口宽度比值．选其≥1的出现率可直接获得神经受压的出现率。     

青少年型电脑颈椎退变X线分析

目的探讨青少年型电脑颈椎退行性变的X线征象及发病机制。方法回顾性分析18例青少年电脑颈椎退变病例影像学资料及临床资料，全部病例均摄取颈椎正侧位及左右斜位、过伸过屈位、开口位X线片。结果18例10例有不同程度的颈椎生理曲度改变，2例椎间关节滑脱移位，1例椎体半脱位，4例椎间隙前窄后宽，3例椎体前扁后宽呈“坡形”椎，1例椎体前缘骨质增生；3例C5-6双侧椎间孔变窄；2例寰枢关节间隙不等宽，前后间隙增宽（〉3mm），呈半脱位。结论青年型电脑颈椎病是由于青少年在学习和工作中过早持久地使颈部过伸或过屈、负荷过重引发的不同于成人颈椎病表现和相应症状的特殊类型颈椎病。     

不同时期颈椎病患者颈椎骨密度变化与椎体变形关系

目的:通过对颈椎病患者X线和颈椎骨密度的测量,探讨不同年龄段颈椎病患者颈椎椎体变形与骨密度变化之间的关系。方法:分3组,正常组20例,平均年龄23岁;颈椎间盘突出症组(颈椎组)22例,平均年龄43岁,腰椎骨密度正常;骨质疏松合并颈椎管狭窄症组(疏松组)28例,平均年龄58岁,腰椎骨密度显示骨质疏松。所有病例测量颈椎侧位C3～C6的椎管、椎体矢状径比,椎体变形指数,C4～C6骨密度。数据进行统计学处理。结果:与正常组相比,颈椎组患者仅在C5,C6椎体出现轻度椎管狭窄,椎体变形,骨密度无明显变化;疏松组则是颈椎高度减低,周径增宽,骨密度升高,3值之间有明显的相关性。结论:椎体骨质疏松的发展与颈椎病的自然发展病程具有明确的相关性,可能是颈椎开始退变进而发展为颈椎病的始动因素之一。     

颈椎间关节面的形态和面积与颈椎病的关系

目的探讨颈椎间关节面的形态和面积与颈椎病的关系。方法在 5 0套增生的成套颈椎骨中 ,调查了不同颈椎的骨质增生率及椎体不同部位的增生率。同时观测另 45套正常成人颈椎标本椎间关节面的形态和面积。结果颈椎间关节面的形态分为圆型、椭圆型和不规则型 ,以椭圆型占优势 ,各节段下关节面的面积均大于上关节面的面积。但仅在C4— 5和C5— 6有显著性差异 (t =2 .0 0 -2 .2 4,P <0 .0 5 )。结论颈椎间关节面的面积和形态与其骨质增生有一定的关系。     

颈椎动态稳定器置入非融合颈椎的生物力学分析

背景:颈椎动态稳定器的解剖型设计与正常椎间盘应具有相似的生物力学特点,其动态性设计具有轴向顺应性以及震荡吸收功能,而前缘倒齿嵌入上下椎体可获得足够的轴向稳定性。目的:比较颈椎前路融合内固定和颈椎动态稳定器置入非融合后颈椎相关生物力学指标变化。方法:将6具新鲜人C2～ C7颈段脊柱标本随机分为3组,在完整颈椎测试后分别行C5、6前路减压颈椎动态稳定器DCI置入,C5、6前路减压单纯Cage融合内固定,C5、6前路减压颈椎前路一体化钢板椎间融合器融合内固定。检测各组标本前屈、后伸、左右侧屈不同生理运动工况并施加2.0N·m纯力偶矩,颈椎标本C5～ 6上下邻近节段手术前后活动度大小。结果与结论:3种内固定后C5～ 6上下邻近节段较正常颈椎标本前屈、后伸和左右侧屈关节活动度值均有所增加,且表现出良好的即时稳定性,但颈椎动态稳定器置入组最接近正常值;3组间C5～ 6上下邻近节段关节活动度差异无显著性意义。表明颈椎动态稳定器置入后对邻近节段椎体活动度无明显影响或影响甚小,在一定程度上减小假体与其邻近椎体轴向应力,有效地维持颈椎活动。     

不同时期颈椎病患者颈椎骨密度变化与椎体变形关系

目的：通过对颈椎病患X线和颈椎骨密度的测量，探讨不同年龄段颈椎病患颈椎椎体变形与骨密度变化之间的关系。方法：分3组，正常组20例，平均年龄23岁；颈椎间盘突出症组（颈椎组）22例，平均年龄43岁，腰椎骨密度正常；骨质疏松合并颈椎管狭窄症组（疏松组）28例，平均年龄58岁，腰椎骨密度显示骨质疏松。所有病例测量颈椎侧位C3－C6的椎管、椎体矢状径比，椎体变形指数，C4－C6骨密度。数据进行统计学处理。结果：与正常组相比，颈椎组患仅在C5，C6椎体出现轻度椎管狭窄，椎体变形，骨密度无明显变化；疏松组则是颈椎高度减低，周径增宽，骨密度升高，3值之间有明显的相关性，结论：椎体骨质疏松的发展与颈椎病的自然发展病程具有明确的相关性，可能是颈椎开始退变进而发展为颈椎病的始动因素之一。     

Morphological Changes of the In Vitro Cervical Vertebral Canal and Its Cast Form During Flexion,Extension, and Lateral Bending

ObjectiveThe purpose of this study was to investigate and measure morphological changes in the vertebral canal and its cast form at the level of the cervical spine in vitro during flexion, extension, and lateral bending in cadaver specimens.MethodsThe morphological changes of vertebral canal and its contents were investigated and measured during experimental flexion, extension, and lateral bending of the cervical spine with 10 fresh specimens (Chinese); the cross-sections and sagittal diameters were also measured by pouring liquid wax into the intervertebral canal.ResultsDuring lateral bending, the nucleus pulposus was pushed to the opposite side and the inferior cervical nerve roots of the opposite side were stretched. Cross-sectional diameter at the level of C6-7 during flexion was larger than that in lateral bending (P < .05). Comparing extension with flexion, we found that changes in all segments' areas were significant (P < .05). There was no significant difference in the sagittal diameter at any segment during all postures (P > .05).ConclusionsDuring lateral bending, the nucleus pulposus of neck were pushed into the opposite side, and inferior cervical nerve roots of the opposite side were stretched. The C5, C6, and C7 nerve roots appeared to undergo excessive stretch when an excessive lateral bending beyond the physiologic range was undergone. This study provides some additional evidence about the mechanics of cervical spine motion.     

An unusual presentation of thyroid papillary carcinoma: Enlargement of a cervical intervertebral foramen

Isolated enlargement of the cervical intervertebral foramen is frequently associated with dumbbell neurogenic tumors. We present an unusual case of isolated enlargement of a cervical intervertebral foramen in a 77-year-old male with an aggressive papillary thyroid carcinoma. To our knowledge, this represents the first case describing a thyroid process as a cause of foraminal enlargement.     

极外型腰椎间盘突出症不同手术入路治疗的探讨

目的:探讨极外型腰椎间盘突出症的不同手术入路的适应证及优缺点。方法:突出位于椎间孔内的3例采用椎管内入路,其中2例保留关节突,1例切除椎弓峡门路及上下关节突。突出位于椎间孔外的3例采用椎旁肌间隙入路。结果:6例均得到随访,其中优5例,良1例,效果满意。结论:位于椎间孔内突出和合并后外侧突出或椎管狭窄的椎间孔内突出应选择椎管内手术入路。向上移位的椎间孔内突出和位于出口区及椎间孔外突出应选择椎旁椎板侧方入路或椎旁肌间隙入路。椎旁肌间隙入路避免了椎板侧方入路骶棘肌过多剥离的缺点,值得推荐。     

颈神经在椎间孔与脊神经沟处受嵌压的出现率比较

背景椎间盘髓核向侧后方脱出以及神经根管内的软组织炎性肿胀可直接或间接压迫神经根,但颈神经在椎间孔及脊神经沟处的嵌压因素与严重性待进一步研究.目的探讨颈神经在椎间孔及脊神经沟处受嵌压的出现率与颈椎病严重程度关系.设计单一样本研究.单位承德医学院解剖教研室、附属医院老年病科、教务处.对象实验选用承德医学院解剖教研室提供的经甲醛固定成尸60具,男28,女32;共120侧.方法取60具成尸,测量颈椎间孔及其脊神经根的外径以及对脊神经沟外口宽度及其沟内段脊神经前支横径,数据进行统计学处理.主要观察指标颈神经前支横径/脊神经沟宽度和颈神经根外径/椎间孔大小的均值,比值≥1的出现率.结果颈神经根与椎间孔之比值明显大于脊神经与脊神经沟之比值(t=2.66,P＜0.01);颈神经在椎间孔处受压的出现率(24.6%)明显高于脊神经沟处(6.3%),二者比较差异有非常显著性意义(x2=6.95,P＜0.01).结论颈神经在颈椎间孔和脊神经沟处均可受累,颈神经在椎间孔处受累的严重性明显大于在脊神经沟处.临床诊治颈椎病在充分考虑椎间孔处神经受累的同时,也不可忽视颈椎脊神经沟处神经受累的可能性.     

Cervical coupling during lateral head translations creates an S-configuration

OBJECTIVE: To determine cervical coupling during the posture of lateral head translation relative to a fixed thoracic cage. DESIGN: Digitized measurements from anteroposterior cervical radiographs of 20 volunteers were obtained in neutral, left, and right lateral translation posture of the head compared to a fixed thorax. BACKGROUND DATA: Clinically, lateral translation of the head is a common posture. Ranges of motion and spinal coupling have not been reported for this movement. METHODS: Vertebral body corners, mid-lateral articular pillars and the superior spinous-lamina junction of C3-T4 were digitized on 60 radiographs. Using the orthogonal axis of positive x-direction to the left, vertical as positive y and anterior as positive z, digitized points were used to measure projected segmental z-axis rotation, y-axis rotation, and segmental lateral translations of each vertebra. RESULTS: Subjects translated their heads laterally a mean of 51 mm. The major coupled motion was lateral bending (z-axis rotation), which changed direction at the C4-C5 disc space creating an S-shape. Upper cervical (C3-C4) lateral bending was contralateral to the main motion of head translation direction. Lower cervical and upper thoracic lateral bending were ipsilateral. Other segmental motions averaged less than 1 mm and 1 degrees. CONCLUSIONS: Lateral head translations (x-axis) compared to a fixed thoracic cage can be large with a mean of 51 mm to one side. The major spinal coupling was lateral bending which changed direction at C4-C5 resulting in an S-configuration. This might have application in side impacts. All other segmental movements were small, less than 1 mm and 1 degrees. RELEVANCE: The clinically common posture of lateral head translation results in an S-shaped cervical spine and may occur in side impact trauma. This posture has not been studied for cervical coupling patterns or range of motion (ROM).     

经皮椎间孔镜髓核摘除术后椎间盘生物力学改变的有限元分析

目的 探讨经皮椎间孔镜髓核摘除术后椎间盘生物力学的变化,以及摘除不同位置和大小的椎间盘对术后椎间盘应力的影响。方法 基于CT扫描数据,建立L₄-L₅椎间盘部分摘除术后腰椎及椎间盘的三维有限元模型,施加载荷后模拟人体7个运动方向（直立、前屈、后伸、左右侧弯、左右旋转）,记录并分析椎间盘的应力变化。结果 髓核去除的6组与正常组比较,不同体位下椎间盘的应力均升高。除旋转体位下,椎间盘应力的改变为A2组 > A1组 > B2组 > B1组,A1组均大于去除面积是其两倍的B2组。左旋转体位下,椎间盘应力增加明显,B2组 > B1组 > A2组 > A1组 > 正常组。在除了侧弯的5种体位下,C2组椎间盘应力为所有组中最高,且C1组应力大于A1组和B1组。结论 腰椎前屈时应力最大。在相同位置,去除椎间盘的大小和其术后应力改变成正相关。椎间盘切除过宽会使其应力增加较大。MSU分型为C型（外侧或极外侧椎间盘突出）,术后椎间盘应力增加最多,是椎间盘去除术后退变的高风险型,B型（旁中央型椎间盘突出）术后椎间盘应力增加最小,是术后的相对稳定型。     

Anatomy of the cervical intervertebral foramina: vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections

Cervical transforaminal epidural steroid injections are performed for the treatment of radicular pain. Multiple recent case reports have raised safety concerns regarding neurologic deficits such as anterior spinal artery syndrome and cerebellar injury after these injections. To investigate the potential causes of these injuries, an anatomic study was conducted. In this study of 10 embalmed cadavers, the cervical intervertebral foramina were examined to determine if the ascending or deep cervical arteries supplied radicular or segmental medullary arteries potentially susceptible to cannulation or needle trauma during transforaminal injection. In two specimens, dissection was carried down to the spinal cord, demonstrating the anterior spinal, radicular, and segmental medullary arteries. Of 95 intervertebral foramina dissected, 21 had an arterial vessel proximal to the posterior aspect of the foraminal opening. Seven of these 21 were spinal branches that entered the foramen posteriorly, potentially forming radicular or segmental medullary vessels to the spinal cord. One additional ascending cervical artery formed a segmental medullary artery that joined the anterior spinal artery. This would only be injured by anterior needle misplacement. Of the seven foraminal branches, three were included in the deep dissections. Two contributed to segmental medullary arteries and one to a radicular artery. Variable anastomoses between the vertebral and cervical arteries were found. Therefore, it is possible to introduce steroid particles into the vertebral circulation via the cervical arteries. Critical arteries are located in the posterior aspect of the intervertebral foramen and may be vulnerable to injection or injury during transforaminal epidural steroid injection.     

CT引导下颈椎椎间孔入路胶原酶溶解术的探讨

目的研究CT引导F经颈椎椎间孔穿刺注射胶原酶治疗颈椎间盘突出症的安全性及疗效。方法对18例颈椎间盘突出症患者在CT扫描定位后用5～7号穿刺针自颈部侧方穿刺,通过相应椎间孔上部达硬膜外侧前间隙,注入胶原酶溶液1200u,随访观察疗效。结果18例均成功,随访6～12月,优良率88．9％,无一例并发症发生。结论CT引导下经椎间孔穿刺注射胶原酶治疗颈椎间盘突出症安全有效,值得进一步研究。     

颈椎病患者145例影像学特征回顾

背景颈椎病各种影像学的征象对于颈椎病的诊断具有重要的参考价值.目的对颈椎病的X线诊断与CT表现进行回顾性分析.设计以诊断为依据的回顾性研究.地点和对象本研究由解放军第四七七医院影像科完成,研究对象为2001/2003本院收治的颈椎病患者145例,男86例,女59例;年龄35～78岁,平均56.5岁.方法收集临床上不同程度颈椎病症状患者145例影像学资料,对其X线和CT表现进行回顾性分析.主要观察指标X线片或CT反映的颈椎骨性改变.结果钩椎关节骨质增生82例,占56.3%;椎间隙狭窄118例,占81.3%;椎间盘突出67例,占46.2%;椎间孔狭窄78例,占53.7%;颈椎骨质增生123例,占84.8%;颈椎生理曲度的改变78例,占53.7%.结论颈椎病在X线与CT表现上具有一定的特征性,同一患者可能存在多种骨性改变.     

Chiropractic management using Cox cervical flexion-distraction technique for a disk herniation with left foraminal narrowing in a 64-year-old man

OBJECTIVE: The purpose of this case report is to describe chiropractic management of a patient with a C6/C7 left posteromedial disk herniation with foraminal narrowing and concomitant neurological compromise in the form of left upper extremity radiating pain and hypoesthesia/anesthesia using Cox flexion-distraction technique. CLINICAL FEATURES: A 64-year-old man presented to a chiropractic clinic with complaints of neck/left shoulder pain and hypoesthesia/anesthesia into the palmar side of his left hand. Magnetic resonance images of the cervical spine revealed a left posteromedial C6/C7 disk herniation along with foraminal narrowing. In addition, there were other levels of degeneration, most noted at the C3/C4 spinal level, which also had significant left-sided foraminal narrowing. INTERVENTION AND OUTCOME: Treatment included Cox flexion-distraction protocols aimed to reduce nerve root compression along with supportive physiological therapeutic interventions to aid with pain reduction and functional improvement. The patient was treated a total of 10 times over a course of 4 weeks. The patient reported being pain-free and fully functional 8 months following the conclusion of care. CONCLUSION: This case study demonstrated the use of Cox flexion-distraction for treatment of a patient with a cervical disk herniation, foraminal narrowing, and associated radiating pain and radiculopathy in the left upper extremity.