USS内固定器治疗腰椎退行性滑脱

目的 探讨腰椎管减压、USS内固定器治疗不稳定型腰椎退行性滑脱早期临床效果。方法 对54例腰椎退行性滑脱症患者行后方入路腰椎管减压、USS内固定手术,对照比较手术前、后临床症状改善和X线片滑脱复位程度进行疗效评定。结果 症状完全消失48例,明显改善6例。54例中24例Ⅰ度滑脱,其中22例术后X线片检查证实完全复位;Ⅱ度滑脱30例,28例完全复位,另2例滑脱部分复位。术后无发生神经系统并发症及感染。结论 USS内固定器治疗腰椎退行性滑脱早期随诊复位满意,疗效良好。     

Stress views in the comparative assessment of spondylolytic spondylolisthesis

Patients with spondylolytic spondylolisthesis were examined in six different positions to detect segmental instability. The amount of displacement was determined on lateral spot radiographs, taken in recumbent, standing, flexion, extension, axial compression, and traction positions in each patient. An error analysis was also performed. Examination in axial compression-traction was found to be a significantly better method for detection of segmental instability compared with standing-recumbent, or flexion-extension radiographs. In addition, the compression-traction method exhibited a higher sensitivity for identification of instability (73%) than standing-recumbent (33%) or flexion-extension (20%) views. The total error in the determination was small, ±2.5% (95% CL), providing a careful and controlled technique was used.     

Spinal lumbar synovial cysts. Diagnosis and management challenge

Sophisticated and newer imaging capabilities have resulted in increased reporting and treatment options of spinal lumbar synovial cysts (LSS). Most of the patients with lumbar cysts tend to be in their sixth decade of life with a slight female predominance. The incidence of LSS is thought to be less than 0.5% of the general symptomatic population. They may be asymptomatic and found incidentally or the epidural growth of cysts into the spinal canal can cause compression of neural structures and hence associated clinical symptoms. Most of the symptomatic LSS patients present with radicular pain and neurological deficits. Spinal synovial cysts are commonly found at L4-5 level, the site of maximum mobility. They may be unilateral or bilateral and at one or multilevel. MRI is considered the tool of choice for its diagnosis. The etiology of LSS is still unclear, but underlying spinal instability, facet joint arthropathy and degenerative spondylolisthesis has a strong association for worsening symptoms and formation of spinal cysts. Synovial cysts resistant to conservative therapy should be treated surgically. Resection and decompression with or without fusion and instrumentation remains an appropriate option. Synovial cysts may recur following surgery. The optimal approach for patients with juxtafacet LSS remains unclear. The best surgical treatment option for each particular individual should be tailored depending upon the symptoms, radiological findings and other co morbidities.     

The effect of synovectomy on the articular cartilage of the knee joint in rabbits

Summary A one stage operation by the posterior route has been carried out in a series of nine patients for the reduction and fusion of severe spondylolisthesis and spondyloptosis. For this purpose special instruments have been designed to exert a controlled force on the displaced vertebra in two perpendicular directions. Technical details of the procedure are reported. Bone is resected from the sacrum and the fifth lumbar vertebra to avoid too much tension on the nerve roots. After the reduction L5 is held in place by two screws and a sacral bar. The lumbosacral kyphosis seen in severe spondylolisthesis can also be corrected by this method.Bone grafts from the ileum or tibia are not needed and lumbosacral fusion is achieved within 3–6 months because of the close contact between the raw bone of the vertebral bodies.All patients achieved a sound fusion with significant remission of symptoms.

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Résumé L'auteur présente la technique de réduction des spondylolisthésis et des spondyloptoses avec arthrodèse stable, par voie postérieure, qu'il a utilisée dans neuf cas.Grâce à une instrumentation spéciale, le glissement de L5 peut être réduit en exerçant une force contrôlée sur la vertèbre listhésique dans deux directions perpendiculaires.Des précisions techniques sont données notamment en ce qui concerne la protection du tissu nerveux. Il faut faire une résection osseuse suffisante au niveau de L5 et du sacrum pour éviter toute lésion neurologique per et post-opératoire.Des greffes tibiales ou iliaques ne sont pas nécessaires, on obtient une fusion solide en trois à six mois, grâce au contact étroit qui s'établit entre l'os spongieux des corps vertébraux. Après réduction L5 est fixée par deux vis et une tige sacrée.Tous les opérés ont présenté une fusion solide ainsi qu'une amélioration considérable de leurs symptômes. La cyphose lombosacrée qui accompagne les spondylolisthésis sévères peut être corrigée par cette méthode.

     

棘突阶梯征在腰椎滑脱中的诊断意义

目的 探讨棘突阶梯征在腰椎真性和假性滑脱时的不同表现及其诊断价值，方法 回顾分析62帧腰椎侧位片，42例诊断为第4或第5腰椎滑脱，20例作为对照，分别由3位医师对每一帧侧位片中L3，L4和L4，L5棘突间的阶梯征进行评价记分。结果 真性腰椎滑脱时棘突阶梯征位于滑脱节段上方水平，假性滑脱时棘突阶梯征位于滑脱节段下方水平。结论棘突阶梯征对真性和假性腰椎滑脱具有鉴别诊断意义。     

螺旋式椎体融合器的研制与应用

目的：通过应用自行研制的螺旋式椎体融合器经后路椎间植骨融合治疗腰椎不稳，以防止因植骨愈合不良而造成的手术失败。方法：１９９１年３月～１９９６年５月应用螺旋式椎体融合器植骨融合治疗腰椎不稳３３例。其中双侧椎弓断裂伴腰椎滑脱１４例，一侧椎弓断裂（无滑脱）伴腰椎间盘突出３例，退变性脊柱滑脱１６例。结果：经１～５年随访，本组病例全部骨性愈合，症状基本消失，无并发症发生。结论：本技术操作简便、骨愈合坚固、能早期下床活动、安全可靠，对保持脊柱长期稳定、巩固疗效有重要作用     

同种异体骨椎体间融合器治疗脊柱滑脱12例

目的 观察同种异体骨融合器治疗脊柱滑脱的效果。方法 选择异体腓骨制作的脊柱融合器5个,金属螺钉4个,测定其力学强度。选择12例脊柱滑脱病人,后路手术进行椎板减压和椎体融合。结果 带孔脊柱融合器的最大强度为7.31±1.3 MPa,最大力0.728±0.09 KN,与金属螺钉最大强度7.14±1.42 MPa,最大力0.711±0.076 KN,比较无差异(P>0.05)。手术病人随访时间6个月,神经根性疼痛症状完全缓解,放射线显示未发生椎体间融合器滑脱、骨折。测定滑脱椎体间距术前平均4.3mm±0.5mm,术后未使用脊柱内固定5例4.2mm±0.7mm,手术前后比较无差异(P>0.05);使用内固定7例滑脱椎体间距为0mm,手术前后比较有差异(P<0.01)。结论 同种异体脊柱融合器力学性能良好,能促进椎体间融合。     

Kinematic evaluation of cervical sagittal balance and thoracic inlet alignment in degenerative cervical spondylolisthesis using kinematic magnetic resonance imaging

Background Context

T1 slope is a novel thoracic parameter used to assess cervical spine sagittal balance. Thoracic index (TI) parameters including T1 slope and cervical sagittal alignment parameters may play an important role in degenerative cervical spondylolisthesis (DCS). Current literature regarding the relationship between TI and cervical sagittal alignment parameters in patients with DCS is limited.