颈椎侧块钢板在脊髓型颈椎病治疗中应用

目的 对15例脊髓型颈椎病患者行后入路椎管减压、椎板成型术的同时使用颈椎侧块钢板固定，探讨和分析该手术方法的优点和手术治疗效果。方法 从自2000年3月—2002年12月，对15例脊髓型颈椎病患者(术前颈椎MR显示有三个节段颈椎椎间盘水平病变并有黄韧带增厚突入椎管)，行颈椎后入路双开门椎板成型术加双侧颈椎侧块钢板固定。按JOA评分法评定患者手术前后恢复情况。结果 本组患者男10例，女5例，随访5个月—1年2个月，平均9个月，术后2—7天(平均3．5天)可戴颈围坐起，颈围外固定时间12周，融合时间3—5个月，(平均为3．5个月)，术后JOA评分明显提高，所有病人无术中血管、神经根损伤，无植骨不愈合，无内固定断裂。结论 行颈椎后入路双开门椎板成型术联合应用颈椎侧块钢板固定，从后方扩大椎管容积，对脊髓进行减压，辅助以侧块钢板对减压后的颈椎行即时的稳定的固定，增加后方所植髂骨的融合成功率，大大地减少颈椎术后后突畸形发生和术后卧床并发症的发生率。     

椎管内肿瘤磁共振成像增强扫描初步观察

对１１例手术病理证实的椎管内肿瘤进行磁共振成像（ＭＲＩ）增强扫描的前、后分析，并对肿瘤定位、定性和鉴别诊断作了初步探讨。根据肿瘤形态、边界、强化程度，及与脊髓、硬脊膜、神经根等关系，ＭＲＩ的增强扫描对提高其定位、定性诊断均有较大的帮助。     

BDNF基因修饰神经干细胞移植后大鼠脊髓损伤移植处的基因表达变化

目的：了解脑源性神经营养因子（Brain-derived neurotrophic factor,BDNF）基因修饰神经干细胞移植到大鼠脊髓损伤处后的基因表达变化，为脊髓损伤修复提供基础研究资料。方法：大鼠随机分为4组：正常对照组，手术对照组，神经干细胞（Neural stem cells,NSCs）移植组，BDNF－NSCs移植组，各组分4个时相点（7d、1个月、2个月、3个月），利用细胞移植、X-gal组化、免疫组化、原位杂交等方法，观察了移植处细胞的标记基因（LacZ）表达和BDNF、胶质纤维酸性蛋白（GFAP）、神经丝－200（NF－200）的表达。结果：大鼠脊髓损伤移植处细胞中，有标记基因阳性细胞，BDNF强烈表达，尤其是BDNF－NSCs移植组的移植后1周和1个月时。各组各时相点均有GFAP和NF－200免疫反应阳性细胞和纤维。结论：BDNF基因修饰神经干细胞能在脊髓损伤移植处存活，强烈表达BDNF，BDNF基因修饰神经干细胞可以作为脊髓损伤修复的移植材料。     

Spinal cord restitution following compression injuries in rats

Spinal cord compression injuries were produced in rats by applying weights to a plate 2.2 x 50 mm in size, placed on the exposed midthoracic dura covering the spinal cord. The influence of force and duration of compression was studied by using 3 different weights, 20, 35 and 50 g, applied for 1, 5 and 10 min. Postoperative neurological function was tested by the inclined plane method and the rats were observed for 3 weeks. Neurological impairment increased with force and duration of compression. It is therefore reasonable to conclude that patients suffering from spinal cord injury should be investigated immediately for signs of persistent cord compression. If this is present, early decompression might be of value, although nothing is known in man concerning the limits of force and duration of compression permitting postoperative neurological recovery.     

红外热像图在神经外科疾病中应用价值的评价

目的 评价红外热像图在神经外科疾病中应用的价值。方法 应用红外热像图对39例脊髓损伤患者进行躯体温度监测，对31例颅内肿瘤、76例脑梗死、2480例头痛、21例头面部血管瘤进行头部温度监测。结果 红外热像图监测脊髓损伤39例，测出脊髓损伤平面上下无温差14例，平面以下温度增高1-3℃ 13例，下降1-3℃ 12例。经大网膜脊髓移植手术13例，术前脊髓损伤平面以下34℃，术后1个月复查皮肤温度，上升至35℃并伴有麻胀和皮肤湿润感7例，皮肤温度下降0．6℃者6例。热像图可显示血管性头痛颞部高温区，眶上神经痛同侧前额部皮肤低温区，枕大神经痛同侧枕颈部热区；热像图可显示梗死侧有低温区；显示颅内肿瘤颈外血管供血情况；基本上能反映头面部血管瘤血管侵及范围。结论 红外热像图在神经外科有其独特的价值，本技术具有无创、可重复、价廉和检查的非接触性等优点，反映组织代谢活跃状态与程度，是CT等形态学诊断方法的补充，在医学科学的研究和临床应用中具有很大的潜力。     

椎管内神经鞘瘤的MRI诊断

目的：提高对椎管内神经鞘瘤的MRI诊断水平。方法：回顾性分析手术病理证实的11例椎管内神经鞘瘤的病理组织学所见及MRI表现。结果：11例MRI检查均清晰显示椎管内神经鞘瘤的形态，信号特征，其中8例在硬膜内，2例居硬膜内外，1例位于硬膜外，1例为多发，增强后瘤体明显强化。结论：MRI对椎管内神经鞘瘤的定位及定性诊断颇有价值。     

病变椎体切除脊柱稳定性重建治疗胸腰椎转移瘤

目的:探讨病变椎体切除脊柱稳定性重建治疗胸腰椎转移瘤可行性与临床价值。方法:1999年7月-2006年4月,采用后正中加后外侧"T"形切口行病变椎体切除、钛网 切除的肋骨或取自体髂骨填充植骨、椎弓根钉棒系统内固定治疗16例胸腰椎转移瘤患者,随访观察患者术后局部疼痛缓解、脊髓神经功能恢复及脊柱稳定性情况。结果:术后患者腰背痛及放射性疼痛基本缓解,均于术后早期开始肢体功能锻炼,术后2-3周离床活动。随访8个月-3年,患者神经系统压迫症状明显改善,3例C级患者2例恢复到D级,1例恢复到E级;D级5例均恢复到E级。影像学复查内固定物无松动、断钉、断棒现象,钛网无移位,椎体无塌陷。结论:经后正中加后外侧"T"形切口手术切除病变椎体并重建脊柱的三柱稳定性结构治疗胸腰椎转移瘤是可行的,可提高患者生存期内的生活质量。     

q-Space diffusion of myelin-deficient spinal cords.

The apparent water diffusion anisotropy in white matter (WM) of excised spinal cords of myelin-deficient (md) rats and their age-matched controls was studied by high-b-value q-space diffusion MRS and MRI at different diffusion times. Non-monoexponential signal decay was observed at long diffusion times. The mean displacements in the md spinal cords were found to be higher than those of the controls. The apparent anisotropy (AA) of the fast-diffusing component was found to decrease more dramatically with the increase in diffusion time for the md spinal cords as compared with controls, whereas the AA of the slow-diffusing component in the controls was found to increase with the increase in diffusion time while that of the md cords decreased with the increase in diffusion time. When diffusion MRI was performed, similar diffusion anisotropy was extracted for the md and control spinal cords at diffusion times of 22 and 50 ms. Only at a diffusion time of about 200 ms was a significant difference obtained in the AA of the two groups. This originates from the much smaller increase in the mean displacement perpendicular to the fiber direction in the control group vs. the md group when the diffusion time was increased.     

Spinal Cord Stimulation in a Mouse Chronic Neuropathic Pain Model

Objective. Development of a spinal cord stimulation (SCS) system in a mouse model of chronic neuropathic pain. Materials and Methods. Male C57BL/6 mice (N = 6) underwent a partial ligation of the sciatic nerve. Development of mechanical hyperalgesia was tested using the withdrawal response to tactile stimuli with the von Frey test. An SCS system was implanted on day 14. On day 16, the mice were stimulated for 30 min (f = 50 Hz; pulse width 0.2 msec and stimulation at 2/3 of motor threshold). Repeated measure analysis of variance (anova ) and paired Student's t‐test with Bonferroni correction were used to evaluate the development of mechanical hyperalgesia and the therapeutic effect of SCS. Results. Five out of six mice developed marked mechanical hyperalgesia in the nerve‐lesioned paw that persisted for the duration of the study (16 days). No changes contralateral to the injury were observed. In four out of five mice, a successful implantation of the electrodes followed by stimulation was achieved. Then, SCS resulted in a fast and robust increase of withdrawal threshold back to pre‐injury levels. After termination of the SCS, the withdrawal threshold of the ipsilateral paw slowly decreased. No effect of SCS on the contralateral paw was noted. Conclusion. The development of a mouse SCS system is described that is practical in use, is reproducible, and shows a comparative therapeutic effect in treatment of chronic neuropathic pain as reported in rat.