一期前后联合入路治疗上颈椎畸形

回顾9倒因颅底凹陷症合并其它畸形在我科接受一期经口咽齿状突切除、后路枕骨大孔减压、寰枢椎或枕颈融合术治疗的临床资料,观察该术式对脊髓功能、枕颈部稳定性的影响及其临床疗效.本组术前诊断均为颅底凹陷症合并邻近结构畸形.所有患者均接受前后联合入路手术.末次随访JOA评分15±1分.影像学检查示齿状突残留基底部均位于钱氏线以下,脊髓减压充分,寰枢间、枕颈间植骨均获坚强融合,融合时间平均3.9±1.1个月.因此一期前后路联合手术治疗颅底凹陷症,脊髓减压充分,重建稳定性后骨融合好,治疗效果满意.     

Ⅰ期颈椎前后路联合手术治疗嵌夹脊髓型颈椎病

为了探讨前后路联合手术治疗嵌夹脊髓型颈椎病的疗效,对50例患者行Ⅰ期颈后路单开门-前路减压内固定术。术后随访脊髓功能改善情况,植骨融合率及并发症。结果显示,50例患者经平均6．5月随访,内固定均获牢固融合,脊髓功能明显改善,无明显并发症。提示Ⅰ期颈椎前后路联合手术是治疗嵌夹脊髓型颈椎病的较理想方案。     

颈椎前后路联合手术治疗严重多节段颈椎管狭窄症的临床疗效评价

对于严重的多节段颈椎管狭窄,单纯前路或后路手术风险大,减压不充分,一期前后路联合手术其可降低单纯前路手术脊髓损伤的风险和减少单纯后路手术的减压不彻底和因脊随后移所致的神经根麻痹.通过随访观察,前后路减压能够显著改善患者症状,提高JOA评分,能够彻底地减压并重建即刻稳定性,是安全有效的手术方式.     

颈椎前后路联合手术治疗严重多节段颈椎管狭窄症的临床疗效评价

对于严重的多节段颈椎管狭窄,单纯前路或后路手术风险大,减压不充分,一期前后路联合手术其可降低单纯前路手术脊髓损伤的风险和减少单纯后路手术的减压不彻底和因脊随后移所致的神经根麻痹。通过随访观察,前后路减压能够显著改善患者症状,提高JOA评分,能够彻底地减压并重建即刻稳定性,是安全有效的手术方式。     

胸椎管狭窄症的临床分型与术式选择

为探讨胸椎管狭窄症的临床分型与术式选择,对35例患者行后路椎管减压术,所有患者术后12个月时ASIA分级均有1级或1级以上的恢复;按Epstein标准：优良率：85．7％;影像学检查示脊髓减压充分,植骨患者术后6个月均达骨性融合。据不同的临床类型选择不同的术式,可取得满意的临床疗效。     

胸椎管狭窄症的临床分型与术式选择

为探讨胸椎管狭窄症的临床分型与术式选择,对35例患者行后路椎管减压术,所有患者术后12个月时ASIA分级均有1级或1级以上的恢复;按Epstein标准:优良率:85.7%;影像学检查示脊髓减压充分,植骨患者术后6个月均达骨性融合.据不同的临床类型选择不同的术式,可取得满意的临床疗效.     

一期颈椎后前路手术治疗伴有后凸畸形的多节段颈椎管狭窄的临床研究

为了研究与探讨一期颈椎后前路联合手术治疗伴有后凸畸形的多节段颈椎管狭窄的临床疗效,回顾性研究2011年3月至2013年2月在我院由同一组外科医生治疗且符合标准纳入研究的患者32例,比较术前与术后的 JOA 评分,颈髓功能改善率,Borden 氏测量法的 D 值,Vas 评分,评估一期颈椎后前路联合手术治疗该疾病的临床疗效。患者术后均随访12个月,患者接受一期后前路手术治疗后双臂双手麻木、间歇性跛行、走路有踩棉花感、肢体感觉障碍症状均有明显改善。一期颈椎后前路联合手术治疗伴有后凸畸形的多节段颈椎管狭窄症,可有效地矫正颈椎的后凸畸形,恢复颈椎正常的生理弯曲,解除颈髓压迫,恢复颈椎生理曲度,是安全有效的手术方法。     

单纯后路手术治疗胸腰椎结核的临床应用

对收治我科的16例胸腰椎结核患者行一期后路病灶清除、植骨融合内固定手术,术后评价结核控制及植骨愈合程度等,并用ASIA分级及评分对神经功能情况进行统计学分析。术后资料示植骨融合、畸形矫正满意,无结核复发。患者感觉和运动功能ASIA评分改善具有统计学意义(P0.05)。因而合理应用本法治疗胸腰椎结核可作为临床骨科医师优先考虑的手术方式。     

单纯后路手术治疗胸腰椎结核的临床应用

对收治我科的16例胸腰椎结核患者行一期后路病灶清除、植骨融合内固定手术,术后评价结核控制及植骨愈合程度等,并用ASIA分级及评分对神经功能情况进行统计学分析.术后资料示植骨融合、畸形矫正满意,无结核复发.患者感觉和运动功能ASIA评分改善具有统计学意义(P＜0.05).因而合理应用本法治疗胸腰椎结核可作为临床骨科医师优先考虑的手术方式.     

不同植骨方式应用于退行性腰椎滑脱症后路手术的疗效分析

为了比较后路椎间植骨融合(posterior lumber interbody fusion,PLIF)、后外侧植骨融合(posterolateral lumbar fu-sion,PLF)及二者联合运用(PLIF+PLF)在退行性腰椎滑脱症后路手术中的疗效,对59例退行性腰椎滑脱症患者根据手术中植骨方式分为三组,回顾三组患者的临床资料,比较三种植骨融合方式手术时间、术中出血量、椎间隙高度、滑脱角、植骨融合率以及JOA评分改善率.结果显示:B组(PLF)的植骨融合率低于A组(PLIF)及C组(PLIF+PLF).在椎问隙高度维持、滑脱角丢失等方面A组优于B组(P<0.05),并且与C组无差异(P>0.05).在手术时间及术中出血量方面A组优于C组(P<0.05),并且与B组无差异(P>0.05).JOA评分改善率比较,三组间无显著性差异(P>0.05).因此,得出结论:PLIF和PLF均是退行性腰椎滑脱症后路手术中的有效融合方式;PLIF及PLIF+PLF的融合率优于PLF;综合分析PLIF应用于退行性腰椎滑脱症后路手术中优于PLF及PLIF+PLF.     

特殊类型的无骨折脱位型颈髓损伤治疗分析

为了探讨多节段后纵韧带骨化伴颈椎间盘突出的无骨折脱位型颈髓损伤的治疗,回顾了本院收治的4例多节段后纵韧带骨化伴颈椎间盘突出的无骨折脱位型颈髓损伤患者的临床资料,并结合相关文献报道进行分析。结果显示,4例患者均早期行前后路联合手术椎管减压,3例患者行预防性气管切开,4例患者术后随访时间6个月～48个月,平均随访24个月。固定节段均获骨性融合,内固定物无松动、断裂;后路手术无再关门现象。术后神经功能评价按Frankel分级,均有1个～2个级别恢复,术前A级2例,B级2例;术后B级2例,C级1例,D级1例。提示对于多节段后纵韧带骨化伴颈椎间盘突出的无骨折脱位型颈髓损伤早期行前后路联合手术减压;预防性气管切开可获得良好的治疗结果。     

Limb-specific emotional modulation of cervical spinal cord neurons

Emotional stimuli receive prioritized attentional and motoric processing in the brain. Recent data have indicated that emotional stimuli enhance activity in the cervical spinal cord as well. In the present study, we used fMRI to investigate the specificity of this emotion-dependent spinal cord activity. We examined whether the limb depicted in a passively viewed image (upper vs. lower) differentially influenced activity in the cervical segments that innervate the upper limbs, and whether this effect was enhanced by emotion. Participants completed four fMRI runs: neutral–upper limb, neutral–lower limb, negative–upper limb, and negative–lower limb. The results indicated main effects of limb and emotion, with upper limbs and negative stimuli eliciting greater activity than lower limbs and neutral stimuli, respectively. For upper-limb runs, negative stimuli evoked more activity than did neutral stimuli. Additionally, negative stimuli depicting upper limbs produced stronger responses than did negative stimuli depicting lower limbs. These results suggest that emotional stimuli augment limb-specific responses in the spinal cord.     

人工颈椎间盘置换术能否取代ACDF

目前颈椎病的治疗主要采用切除病变椎间盘和椎体间融合的手术方法,而人工颈椎间盘置换术的临床应用预示着脊柱外科治疗学新纪元的开始。简要介绍了Byran人工颈椎间盘置换术,对其临床效果进行了随访和分析,总结了人工颈椎间盘置换术的治疗优势和临床应用中的问题。客观评价了人工颈椎间盘技术,为临床决策提供了实践依据。     

Method for studying spinal evoked potentials]

The authors describe a new method of examing evoked spinal potentials. Derivation is by means of unipolar needle electrodes which are ventrolaterally introduced into the cervical disk space as far as the posterior longitudinal ligament. Detection of a spinal potential following the stimulation of brachial and crural nerves allows to exclude the possibility of complete transverse lesion of the spinal cord or severing of the peripheral nerve or plexus.     

Sparing and recovery of function in spinal larval frogs (Rana catesbeiana): effect of level of transection.

Bullfrog tadpoles with cervical or midthoracic transection of the spinal cord were allowed to recover for 5 weeks, at which time axonal growth across the transection site was assessed by transport of horseradish peroxidase. Weekly behavioral tests included those for posture, spontaneous locomotion, cutaneously elicited swimming, and intersegmental coordination. Behavioral and electrophysiological assessments suggest that behavioral recovery depends, at least in part, on the growth of fibers across the transection site. Anatomical and behavioral recovery does not appear to differ with the level of spinal transection, but there was greater sparing of posture, spontaneous locomotion, and stimulus-induced locomotion in tadpoles with thoracic transection of the spinal cords.     

Synergistic influences of sensory and central stimuli on non-voluntary rhythmic arm movements

In recent years, neuromodulation of the cervical spinal circuitry has become an area of interest for investigating rhythmogenesis of the human spinal cord and interaction between cervical and lumbosacral circuitries, given the involvement of rhythmic arm muscle activity in many locomotor tasks. We have previously shown that arm muscle vibrostimulation can elicit non-voluntary upper limb oscillations in unloading body conditions. Here we investigated the excitability of the cervical spinal circuitry by applying different peripheral and central stimuli in healthy humans. The rationale for applying combined stimuli is that the efficiency of only one stimulus is generally limited. We found that low-intensity electrical stimulation of the superficial arm median nerve can evoke rhythmic arm movements. Furthermore, the movements were enhanced by additional peripheral stimuli (e.g., arm muscle vibration, head turns or passive rhythmic leg movements). Finally, low-frequency transcranial magnetic stimulation of the motor cortex significantly facilitated rhythmogenesis. The findings are discussed in the general framework of a brain-spinal interface for developing adaptive central pattern generator-modulating therapies.     

Spinal and locus coeruleus noradrenergic lesions abolish the analgesic effects of 5-methoxy-N,N-dimethyltryptamine

Two experiments were performed on Sprague-Dawley rats to study the effects of noradrenaline and 5-hydroxytryptamine depletion upon the antinociceptive effects of acute 5-methoxy-N,N-dimethyltryptamine (5-MeODMT) administration. 6-Hydroxydopamine-induced lesions following microinjections to either the locus coeruleus or the spinal cord (lumbar) abolished completely 5-MeODMT-induced analgesia in the tail-flick, hot-plate, and shock titration tests whereas 5,7-dihydroxytryptamine-induced lesions of the nucleus raphe magnus and the lumbar spinal cord attenuated 5-MeODMT analgesia in the tail-flick and shock titration tests. Thus, the experiments serve to demonstrate an important interaction between descending noradrenergic and serotonergic pathways, possibly at a spinal locus.