下颈椎后路固定方法的力学比较

目的：评价不同于颈椎后路内固定器的生物力学性能。方法：应用５具新鲜尸体颈椎标本（Ｃ２￣Ｃ７）建立脱位模型后,依次用棘突钢丝、侧块螺钉、自制螺钉、椎弓根螺钉固定,用材料试验机测算其垂直压缩刚度,前后水平剪切刚度和左右水平剪切刚度。结果：棘突钢丝的垂直压缩刚度和前后剪切刚度虽较完整颈椎增大,但无显著性差异（Ｐ〉０．０５）,而左右剪切刚度尚较完整颈椎减小（Ｐ〈０．０５）。侧块螺钉、自制螺钉和椎弓根螺钉的     

沈氏装置稳定性的生物力学评价

评价沈氏经椎弓根内固定装置的生物力学稳定性。方法采用５具新鲜尸体脊柱标本,制造Ｌ１损伤模型,测量并比较标本在完整状态,损伤状态、沈氏装置固定、沈氏装置疲劳及ＣＤ装置固定下的Ｔ１２和Ｌ２之间的三维运动范围,并将沈装置与ＣＤ装置固定下的运动范围进行,经统计学处理,评价沈氏装置的稳定性。     

The effect of accident mechanisms and initial findings on the long-term course of whiplash injury

The aim of this study was to assess the relationships between accident mechanisms as well as initial findings and the long-term course of whiplash injury. A representative sample of 117 consecutive patients referred by primary care physicians was followed-up over 12 months. Fractures or dislocations of the cervical spine, head trauma and pre-existing neurological disorders were exclusion criteria. The interval between the accident and the baseline examination was 7.4 days (SD 4.2 days). Assessment included accident features (e.g. passenger position in the car, head restraint, head position, type of collision), initial symptoms (e.g. intensity and onset of pain, symptoms of neurological dysfunction, multiple symptom score), and signs (restricted neck movement, neurological deficits). At the 1-year examination, patients were divided into an asymptomatic and a symptomatic group and were compared with respect to accident features and baseline findings. Twenty-four percent of patients were still symptomatic after 1 year. Analysing accident mechanisms separately, rotated or inclined head position was the primary feature related to symptom persistence (P=0.005). The symptomatic group scored higher at baseline on the multiple symptom rating (P=0.004) and had a higher incidence of initial headache (P=0.004) and neurological symptoms (P=0.008) together with a higher intensity of headache (P=0.0002) and neck pain (P=0.0009). The following set of initial variables predicted persistence of symptoms at 1 year (logistic regression): intensity of neck pain (P=0.001) and headache (P=0.009), rotated or inclined head position (P=0.02), unpreparedness at the time of impact (P=0.01) and car stationary when hit (P=0.01). In conclusion, accident mechanisms and initial findings suggestive of more severe injury were significantly related to long-term persistence of symptoms after whiplash injury.This study was supported by the Swiss National Science Foundation (project number: 3.883-0.88) and the Swiss Accident Insurance Company (Schweizerische Unfallversicherungsanstalt), Berne     

MR evaluation: Spine changes after radiotherapy

ＫｎｏｗｌｅｄｇｅｏｆｔｈｅＭＲＩｃｈａｒａｃｔｅｒｉｓｔｉｃｓｏｆｓｐｉｎｅａｆｔｅｒｒａｄｉｏｔｈｅｒａｐｙｉｓｅｓｓｅｎｔｉａｌｉｎｄｉｆｅｒｅｎｔｉａｔｉｎｇｎｏｒｍａｌｐｏｓｔ－ｉｒｒａｄｉａｔｉｏｎｃｈａｎｇｅｓｆｒｏｍｏｔｈｅｒｖｅｒｔ...     

Surgically Controlled, Transpedicular Methyl Methacrylate Vertebroplasty with Fluoroscopic Guidance

Summary  The authors report a series of 13 patients with osteoporotic vertebral fractures treated by transpedicular vertebroplasty. Because of a neurological complication due to posterior leakage of acrylic cement the classical percutaneous approach was converted to an open surgical procedure. The latter allows direct visual control of neural structures and immediate removal of spilled cement, thus eliminating the danger of compressive, chemical and thermal effects of methyl methacrylate on neural elements.  By use of this elegant technique primary stability of fractured vertebras is obtained leading to prompt pain relief in all patients. Surgically controlled vertebroplasty can be used in conjunction with internal fixation. By having studied the different ways of cement escape in their patients, the authors are convinced that surgically controlled vertebroplasty is safer than percutaneous vertebroplasty.     

Bilateral traumatic abducens nerve paralysis with cervical spine flexion injury

Bilateral traumatic abducens nerve palsy is a rare condition. We report a case associated with cervical spine flexion injury. This may be the first such case report, as no similar case was found in our review of the literature. The mechanisms of injury in this case are relevant to theories that explain hyperextension injuries.     

Lumbar disc herniation in teenagers

Summary We report 48 patients operated on for lumbar disc herniation in the second decade of life (aged 13–20 years) in our Neurosurgical Division. To analyze the clinical and diagnostic features and surgical outcome of the disease in teenagers and to point out any differences from adults, we made a detailed study of over 900 juvenile cases and compared them with 11000 adult cases reported in the literature. Low-back pain proved to be less frequent among youngsters both as a first symptom and at diagnosis, while sensorimotor deficits have the same frequency in the two age groups. Herniation occurs more often at L4–L5 and is more frequently median among teenagers. The long-term surgical results in children and adolescents are better than in adults.     

Unusual fractures and dislocations of the axis vertebra

Seven percent of 400 patients with cervical spine fractures and/or dislocations had unusual lesions of the axis. The authors have analyzed axis injuries by review of radiographs and clinical data and have derived a classification of traumatic conditions. Uncommon traumatic axis abnormalities are discussed with reference to incidence, causes, clinical findings, mechanism of injury, and roentgen characteristics.Picker Scholar, James Picker Foundation     

颈椎关节突交锁的诊断与外科治疗

本文报告从1991年12月至2001年12月诊治的14例陈旧性颈椎关节突交锁患者,受伤至入院时间平均3.9个月(1～10个月)。脱位节段:C_(3～4) 2例,C_(4～5)4例,C_(5～6)5例,C_(6～7)3例。单侧脱位9例,双侧脱位5例。本组患者均有被误诊、误治的病史。在交锁关节突切除,脱位节段植骨融合的基础上,分别采用4种复位固定方法。术后随访平均2年8个月(6个月～5年3个月),9例患者中有7例神经症状有不同程度的改善。本文还对该病的诊断要点,误诊误治原因及目前的处理观点等问题作了讨论。     

酸枣仁油的毒理学研究

目的：评价酸枣仁油的用药安全性。方法：常规毒性实验和血液生化检查。结果：酸枣仁油对大小鼠均未测出LD50，家兔皮肤刺激实验未见急性毒性反应。大鼠的体重、血液学检查、血液生化学检查无显著性差异，大鼠的心、肝、脾、肺、肾、肾上腺、胸腺、睾丸、子宫、卵巢等器官肉眼观察及病理切片先镜检查，均未发现明显病理改变。豚鼠皮肤、兔眼睛及阴道局部应用，未见明显刺激反应。豚鼠皮肤未见过敏反应。结论：临床应用酸枣仁油并无毒性。