椎动脉型颈椎病的彩色多普勒超声诊断

目的 :观察椎动脉型颈椎病的高频彩色多普勒表现和血流动力学变化。方法 :应用彩色多普勒超声诊断仪 (高频探头 ,频率 7～ 10MHz)检测 138例椎动脉型颈椎病患者 (颈椎病组 )的椎动脉 (VH)内径 (D)、血流速度 (V)和血流量 (Q)、阻力指数 (RI)和搏动指数 (PI) ,观察其形态结构、并与 10 0例 (对照组 )进行对照分析。结果 :颈椎病组VA的V(除平均血流速度外 )、D ,Q ,RI,PI与对照组比较差异有显著性 (P <0 0 1)。结论 :高频彩超显示的椎动脉形态和血流参数变化为临床评价椎动脉型颈椎病治疗效果提供了有价值的依据     

Fusion and failure following anterior cervical plating with dynamic or rigid plates: 6-months results of a multi-centric, prospective, randomized, controlled study

Anterior cervical plate fixation is an approved surgical technique for cervical spine stabilization in the presence of anterior cervical instability. Rigid plate design with screws rigidly locked to the plate is widely used and is thought to provide a better fixation for the treated spinal segment than a dynamic design in which the screws may slide when the graft is settling. Recent biomechanical studies showed that dynamic anterior plates provide a better graft loading possibly leading to accelerated spinal fusion with a lower incidence of implant complications. This, however, was investigated in vitro and does not necessarily mean to be the case in vivo, as well. Thus, the two major aspects of this study were to compare the speed of bone fusion and the rate of implant complications using either rigid- or dynamic plates. The study design is prospective, randomized, controlled, and multi-centric, having been approved by respective ethic committees of all participating sites. One hundred and thirty-two patients were included in this study and randomly assigned to one of the two groups, both undergoing routine level-1- or level-2 anterior cervical discectomy with autograft fusion receiving either a dynamic plate with screws being locked in ap - position (ABC, Aesculap, Germany), or a rigid plate (CSLP, Synthes, Switzerland). Segmental mobility and implant complications were compared after 3- and 6 months, respectively. All measurements were performed by an independent radiologist. Mobility results after 6 months were available for 77 patients (43 ABC/34 CSLP). Mean segmental mobility for the ABC group was 1.7 mm at the time of discharge, 1.4 mm after 3 months, and 0.8 mm after 6 months. For the CSLP- group the measurements were 1.0, 1.8, and 1.7 mm, respectively. The differences of mean segmental mobility were statistically significant between both groups after 6 months (P = 0.02). Four patients of the CSLP-group demonstrated surgical hardware complications, whereas no implant complications were observed within the ABC-group (P = 0.0375). Dynamic plate designs provided a faster fusion of the cervical spine compared with rigid plate designs after prior spinal surgery. Moreover, the rate of implant complications was lower within the group of patients receiving a dynamic plate. These interim results refer to a follow-up period of 6 months after prior spinal surgery. Further investigations will be performed 2 years postoperatively.     

Analysis of five specific scores for cervical spondylogenic myelopathy

The ability to compare various results that measure clinical deficits and outcome is a necessity for successful worldwide discussion about cervical spondylogenic myelopathy (CSM) and its treatment. There is hardly any information in literature how to value and compare outcome assessed by different scores. In a retrospective study we objectively evaluated the Nurick-score, Japanese-orthopaedic-association-score (JOA-Score), Cooper-myelopathy-scale (CMS), Prolo-score and European-myelopathy-score (EMS) using the data of 43 patients, all of whom showed clinical and morphological signs of CSM and underwent operative decompression. The scores were assessed pre- and postoperatively. The correlation between the score-results, anamnesis, clinical and diagnostic data was investigated. All the scores show a statistically significant correlation and measure postoperative improvement. With exception of the Prolo-score all scores reflect clinical deficits of CSM. The Prolo-score rates the severity of CSM on the state of the economic situation above clinical symptoms. The main differences of the scores are shown in the number of patients showing postoperative improvement, varying between 33% (Nurick-score) and 81% (JOA-score). The recovery-rates, as a measure of the cumulative improvement of all the symptoms, show less variation (23–37%). The differences of the recovery-rate were only statistically significant between JOA-score, Nurick-score and EMS (P < 0.05), whereas all the other scores showed no significant differences. To assess the postoperative successes, the evaluation of the recovery-rate is essential. There is no significant difference in the recovery-rate amongst the majority of the scores, which allows a good comparison of the results from different studies. Nevertheless, it is always important to differentiate the therapy results of CSM published worldwide.     

经前路颈椎多节段椎管扩大术的实验研究

目的设计颈椎前路椎管扩大术式并探讨该术式的可行性,为颈椎管多节段狭窄症提供新的手术方法。方法标本实验:选用4具C1～T1尸体颈椎标本,去除前方肌肉,保留后侧肌肉及固有韧带,解剖出横突孔,沿椎动脉走行,穿入直径3mm橡胶管,注入造影剂。沿C4～6椎体前正中纵行劈开,依次横向撑开3、6、9、12mm,并用木块填塞,三维CT下观察椎管前后径、横径、截面积、两侧椎动脉的直径、间距,神经根管变化。动物实验:用4只成年绵羊,麻醉后暴露出C3,4颈椎前方,将C3,4椎体纵向劈开,横向撑开9mm,取同侧胫骨9mm×9mm×15mm骨块植入撑开区。术后观察四肢运动恢复情况。结果标本在撑开3、6、9mm后,椎管前后径平均增加1.14%、3.53%、5.15%,横径增加7.92%、14.62%、22.74%,截面积增加8.52%,17.99%,25.01%;在撑开3、6、9mm时,两侧椎动脉走行间距平行,撑开12mm时,在C3,4和C6,7椎间椎动脉间距相差2mm,但走行无折屈、受压。撑开前后神经根管各径及长度无变化。标本在撑开3、6、9mm时未见骨折,撑开12mm时2具左侧、1具右侧椎板靠近棘突部骨折,均为裂纹骨折,无移位。4只绵羊术后第2d四肢可以自由行走,无神经、血管损伤征兆。结论经前路颈椎体纵向劈开扩大术,可以增加椎管容积、不影响脊柱三柱稳定结构。动物实验表明椎体横向撑开一定范围内(≤9mm)对颈髓及周围组织无损伤迹象。实验结果初步证实经前路颈椎椎管扩大术安全有效。     

Radiologic long-term results after cervical vertebral interbody fusion with Polymethyl Methacrylat (PMMA)

Long-term results of cervical interbody fusion with PMMA were evaluated in a retrospective study. X-ray films of 83 patients were obtainable. Post-operative follow-up in this series was between 15 and 20 years. The results show that PMMA is engrafted after about 2 years. Stable vertebral interbody fusion is obtained in about 90% of cases. Development of malignoma was not observed. Resorptive bone alterations, which can be seen in about 2% of cases one to two years after operation are shown not to be progressive. This process heals and stable fusion develops.     

颈椎间盘突出的MRI诊断价值(附41例分析)

目的：探讨颈椎间盘突出的ＭＲＩ诊断。方法：对４１例椎间盘突出进行磁共振成像检查。结果：表明本病可分为中央型和侧方型突出。ＭＲＩ可直接显示颈椎间盘突出的部位、类型及颈髓和神经根的受压程度。结论：ＭＲＩ对本病的确诊具有重要价值     

Preliminary evaluation of cyto-rich: An improved automated cytology preparation

A new cervical cytology monolayer preparation system called Cyto-Rich was evaluated. Using samples from 557 patients, Cyto-Rich monolayers were compared to matched conventional smears. After conventional smears were prepared and spray fixed, residual exfoliated cells were transferred to preservative fluid. The cell suspensions were gently disaggregated and the epithelial component enriched with gradient centrifugal sedimentation. The batched samples were then placed on the Cyto-Rich work station where slides are automatically prepared and stained. The results demonstrate that Cyto-Rich prepared monolayers are vastly superior to the conventional smears for cell presentation. While the study showed 99% overall concordance, Cyto-Rich improved the detection of low-grade cervical intraepithelial lesions.     

双减压椎间融合术治疗椎动脉型颈椎病（附24例报告）

从1987年2月至1991年10月对24例诊断明确的椎动脉型颈椎病患者进行了双减压椎间融合术(BIFO)。其方法是在病变侧行横突前弓及钩椎关节骨赘切除,并行病椎椎间盘切除植骨融合。术后经1.5～5.2年随访,除2例恢复较慢外余皆在不同时间内康复,近远期效果满意。认为BIFO术式是既能去除椎动脉受压主要因素,又能稳定椎体,是一种新的有效的手术治疗方法。     

人乳头瘤病毒感染的局部免疫反应

本文应用ABC法对30例尖锐湿疣(CA)和30例宫颈癌(CCU)进行原位观察,分析对比两者浸润单一核细胞(MNC)的亚群组成、分布及活化状态。结果提示,两者局部免疫均受抑制,而以宫颈癌为甚。依此本文对不同类型HPV相关疾病的局部免疫反应状态及宿主对不同型别HPV感染的免疫反应进行探讨。     

Oblique transcorporeal approach to anteriorly located lesions in the cervical spinal canal

Summary The technique of obliquely drilling out the postero-lateral part of the cervical vertebral bodies is described. It uses the antero-lateral (retro carotico-jugular) approach to control and displace the vertebral artery postero-laterally and to expose the lateral aspect of the vertebral bodies. It provides, through a wide field and with minimal retraction of the carotid artery and the internal jugular vein, an extensive view of the anterior aspect of the spinal cord. It has already been used to treat 15 anterior lesions compressing the spinal cord including neurinomas and osteophytes.