胸腰椎骨折稳定性评分的研究

目的通过对胸腰椎骨折的X线片、CT、MRI表现的研究,得出判断骨折稳定性的评分标准,指导临床治疗。方法基于三柱理论结合胸腰椎骨折分类方法,对60例胸腰椎骨折的X线、CT、MRI片分别进行评价记分,然后分别以改良的Denis脊柱骨折稳定性判断标准结合AO骨折分类方法和McAfee胸腰椎骨折分类法及其稳定性划分为标准进行检验,并应用SPSS13.0软件进行统计学分析,绘制ROC(receiver operating characteristic)曲线,以评估评分方法的临床价值。结果通过绘制ROC曲线并计算ROC曲线下面积,得出两种检验方法的结果分别是:面积(AO)=0.938、面积(McAfee)=0.927,均>0.9。表明利用本评分方法评判胸腰椎骨折稳定程度的敏感性较高。结论本评分方法具有较高准确性,可以为胸腰椎骨折治疗的选择提供可靠依据,是一种判断胸腰椎骨折稳定性切实可行的方法。     

一期后路VCR技术治疗活动期胸腰段脊柱结核伴严重后凸畸形

目的:评估一期后路全脊椎截骨(VCR)技术治疗活动期胸腰段脊柱结核伴严重后凸畸形的疗效.方法:自1998至2006年活动期胸腰椎结核伴严重僵硬角状后凸畸形患者36例,均应用VCR技术行一期后路全脊椎截骨矫形脊髓减压术,术后外支具制动3个月.所有病例随访至少2年,随访期间每6个月进行l临床评估和放射学检查.结果:无围手术期死亡发生,平均手术时间208(145～385)min,后凸Cobb角从术前平均57.2°(17°～86°)矫治到术后平均为8.9°(-6°～27°),C7-S1水平距离术前平均为13.6(8～19)mm,术后平均为3.6(-11～9)mm.术前有神经症状功能障碍者19例,术后神经功能改善率89.5%(17/19).围手术期并发症发生率为8.3%(3/36),包括肺炎和表层伤口感染,随访期并发症发生率为5.5%(2/36),表现为内固定植入物松动,25例(69.4%)获得良好的骨性融合.随访期间,25%(9/36)的患者对治疗结果非常满意,66.7%(24/36)的患者对治疗结果满意,2例一般,1例不满意.结论:一期后路VCR技术是一种治疗活动期胸腰段脊柱结核伴严重后凸畸形安全有效的外科手术方法,该手术技术要求高,外科医师必须熟练病理解剖并谨慎实施.     

一种“新”的不稳定性胸腰椎压缩劈裂骨折

本文报道9例在CT 和X 线平片上都有同一类型病理变化、发病机理和临床过程的胸腰椎压缩劈裂骨折.CT 上的共同病理变化为:(1)骨折椎的上椎间盘损伤;(2)椎体上1/2的压缩骨折:(3)椎体下1/2的矢状劈裂骨折:(4)椎管前部出现椎体中柱骨折块:(5)椎板骨折.通过对本类骨折的力学分析,作者认为这是—种独立的不稳定性爆裂骨折,且有神经性不稳定的特征.临床治疗应切开复位,并使用有撑开效应的固定器.     

无症状中国年轻人颈椎矢状位曲度正常值及其与全脊柱平衡的关系

目的：探讨无症状中国年轻人颈椎矢状位曲度的正常值及其与全脊柱平衡的关系。方法：2011年11月—2014年12月招募并选择年龄18～30岁的志愿者行全脊柱侧位X线检查,在X线片上测量指标包括C₀-C₂角、从C₂-C₃到C₆-C₇的间盘角、从C₃到C₇的椎体角、T₁倾斜角、胸椎后凸角(thoracic kyphosis, TK)、腰椎前凸角(lumbar lordosis, LL)、骨盆入射角(pelvic incidence, PI)、骶骨倾斜角(sacral slope, SS)、C₂-C₇矢状轴向垂线(C₂-C₇ sagittal vertical axis, C₂-C₇SVA)、头重心至C₇的矢状位轴向垂线(center of gra...     

TBL联合CBL教学法在脊柱外科临床教学中的应用

脊柱外科研究生的临床教学是医学院校教学工作的重点和难点,而临床教学方法是脊柱外科临床教学的关键。本文对当前脊柱外科研究生临床教学存在的问题,以及 TBL 教学法和 CBL 教学法联合应用于脊柱外科研究生的临床教学进行探讨。     

下腰椎骨折并发马尾综合征的手术疗效分析

目的:马尾综合征(CES)包括下腰痛、坐骨神经痛、下肢运动感觉功能障碍、会阴区麻木,以及膀胱直肠功能障碍或丧失,CES的一些认识已经明确,但是临床上采取什么样的治疗最恰当存在争议,有关腰椎间盘突出引起的CES,已经积累了大量的病例资料。但是有关下腰椎骨折引起的马尾综合征临床少有报道。方法:从1998年到2006年,收集17例L2—5腰椎骨折并发马尾综合征的病人,其中车祸伤11例,高处坠落伤6例,脊髓圆锥损伤导致的CES的病例除外,记录所有病例的体征、受伤机制、影像资料、受伤时间、手术方法、神经损伤和恢复情况。结果:所有病例随访至少12个月。所有的病人在出现CES48小时之内进行手术减压治疗,其中14个病人恢复效果满意,另外3个病人虽然在伤后24小时内进行了手术治疗,但是效果不好。双下肢无力在4个月内恢复,膀胱和直肠功能在3个月恢复。总的来看,病人恢复效果的好坏与手术时间的早晚无关。结论根据临床研究,下腰椎骨折引起的CES恢复效果与受伤时马尾损伤的程度密切相关,虽然对于手术的时机存在争议,但是本研究建议在出现CES48小时内施行手术治疗。     

多级图像对比增益(MUSICA)在全脊柱摄影后处理中的应用探讨

目的：探讨用计算机摄影（Computer radiography）进行全脊柱摄影时，运用多级图像对比增益（MUSICA）软件后处理技术的临床价值。方法：应用全脊柱专用暗盒架（2～3个IP板）一次曝光，分别逐个采集IP板信息至图像后处理工作站。经全脊柱模式对所选多幅图像执行自动化图像拼合，生成一幅完整全脊柱片。结果：2500例全脊柱图像明显得到优化。结论：多级图像对比增益（MUSICA）的应用，为临床科医生测量脊柱（COBB角）的精确度、制定术前方案、术后疗效提供了更多的信息资料。     

A case report on a child with fracture and dislocation of the upper cervical spine accompanied by spinal cord injury

Rationale:This study describes an 8-year-old boy with a C2 fracture and dislocation with a left C2–C3 articular process interlocking and spinal cord injury who underwent open reduction and internal fixation using the posterior cervical approach and achieved satisfactory results.Patient concerns:An 8-year-old boy underwent an emergency transfer from a previous hospital after a car accident.Diagnoses:Axial fracture and dislocation with spinal cord injury (American Spinal Injury Association grade C), traumatic shock, brain contusion, intracranial hemorrhage, mandibular fracture, pulmonary contusion and hemorrhage, left vertebral artery stenosis, and multiple fractures throughout the body. Radiological examination revealed a fracture of the lower edge of the C2 vertebral body, fourth-degree anterior spondylolisthesis of the C2 vertebral body, interlocking of the left C2–C3 articular processes, widening of the C2–C3 vertebral space, and occlusion of the V1 and 2 segments of the left vertebral artery.Interventions:The boy was immediately intubated and transferred to the pediatric intensive care unit for rescue treatment. However, the reduction was unsuccessful with 2 weeks of cranial traction. Thus, an open reduction was performed under general anesthesia. One month after the surgery, the boy was discharged from the hospital on foot after rehabilitation treatment.Outcomes:The boy was discharged from the hospital 1 month after surgery. At the 8-month follow-up, a radiological examination showed that the corrected C2 vertebral body fracture and dislocation were satisfactorily reduced, and the spinal cord was adequately decompressed. The internal fixation position was also good, and the spinal sequence had recovered well. In summary, except for the muscle strength of the right upper limb, which was slightly worse, the other clinical symptoms were significantly improved.Lessons:In treating cervical fracture and dislocation with unilateral facet lock, the posterior open reduction of pedicle screw and lateral mass screw internal fixation achieved satisfactory results. Consequently, treating complex cervical spine injuries in children requires an accurate diagnosis and careful treatment strategy.     

Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review

Background: Craniovertebral junction (CVJ) schwannomas are rare, with surgery and stereotactic radiosurgery (SRS) being effective yet challenging options. We systematically reviewed the literature on CVJ schwannomas. Methods: PubMed, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA statement to include studies reporting CVJ schwannomas. Clinical features, management, and outcomes were analyzed. Results: We collected 353 patients from 101 included articles. Presenting symptoms were mostly neck pain (30.3%) and headache (26.3%), with most cranial neuropathies involving the XII (31.2%) and X (24.4%) nerves. Most tumors originated from C2 (30.9%) and XII (29.4%) nerves, being extracranial (45.1%) and intradural-extradural (44.2%). Erosion of C1–C2 vertebrae (37.1%), the hypoglossal canal (28.3%), and/or jugular foramen (20.1%) were noted. All tumors were operated, preferably with the retrosigmoid approach (36.5%), with the far-lateral approach (29.7%) or with the posterior approach and cervical laminectomy (26.9%), far-lateral approaches (14.2%), or suboccipital craniotomy with concurrent cervical laminectomy (14.2%). Complete tumor resection was obtained most frequently (61.5%). Adjuvant post-surgery stereotactic radiosurgery was delivered in 5.9% patients. Median follow-up was 27 months (range, 12–252). Symptom improvement was noted in 88.1% of cases, and cranial neuropathies showed improvement in 10.2%. Post-surgical complications occurred in 83 patients (23.5%), mostly dysphagia (7.4%), new cranial neuropathies (6.2%), and cerebrospinal fluid leak (5.9%). A total of 16 patients (4.5%) had tumor recurrence and 7 died (2%), with median overall survival of 2.7 months (range, 0.1–252). Conclusions: Microsurgical resection is safe and effective for CVJ schwannomas. Data on SRS efficacy and indications are still lacking, and its role deserves further evaluation.     

多模式神经电生理监测在颈椎前路手术中的应用

目的 探讨多模式神经电生理监测(MIOM)在颈前路手术中的应用价值.方法 53例颈椎前路手术患者采用术中MIOM监测,记录术中各个阶段的报警情况,并采取相应措施,使术中脊髓神经损伤的可能性最小化.分析术中警报按类型、原因、术前诊断以及手术方式之间的关系,通过神经电生理监测结果以及手术前后JOA评分对手术疗效进行分析.结果 与术前基准电位相比较,术毕SEP及MEP波幅均有所提高,而潜伏期均未有明显改变.术后JOA评分较术前有明显改善(P＜0.05).脊髓型颈椎病患者以及行椎体次全切手术者术中监测“严重警报”发生率较高.结论 颈前路手术中多模式神经电生理监测能有效降低术中神经功能损伤,降低手术风险并能作为手术疗效评价以及神经功能恢复情况的客观依据.