原发性颈椎间隙化脓性感染是颈椎间盘、相邻软骨终板、椎体等较为少见的感染性病变.本病发病隐匿,临床表现缺乏特异性,容易发生漏诊、误诊等.伴随病情的加重,早期即可出现严重的神经功能障碍.脊柱椎间隙感染中发生于颈椎者最为少见;且关于颈椎间隙感染方面报道的文献较少.本文报道一例原发性颈椎间隙化脓性感染患者临床资料,并结合该病研究进展、争议点进行文献回顾.

创伤性髓核脱出症(traumatic nucleus pulposus prolapsus,TNPP)通常由严重脊柱创伤导致[1].当发生无明显脱位的轻微骨折时,由于椎间盘的生物力学特点,其产生剪切和扭转暴力也可导致髓核脱出,并伴有严重神经损伤[2-3].现报告1例无脱位型胸腰段骨折,合并严重神经症状的病例.

胆管细胞癌发生脊柱骨转移少见,以溶骨性病变为主;而脊柱成骨性转移瘤罕见,仅约占脊柱转移瘤的1.6％[1];国内文献鲜有报道胆管细胞癌脊柱成骨性转移瘤.本院脊柱外科收治1例胆管细胞癌源性、成骨性脊柱多发转移瘤患者,现报告如下.

目的 探讨老年患者脊柱术后发生谵妄的相关危险因素.方法 选取358例在静脉吸入复合麻醉下行脊柱手术患者(年龄≥60岁)的基本资料,根据术后是否发生谵妄将患者分为谵妄组与非谵妄组.对患者的年龄、性别、BMI、是否有基础疾病(高血压、糖尿病、冠心病)、手术部位、手术时间、术中出血量、术后发热情况、术后低氧血症及实验室检查结果等因素进行统计,分析各因素对老年患者脊柱术后谵妄发生的影响.结果 37例发生术后谵妄,发生率为10.3％.单因素分析结果显示,年龄、性别、手术时间、手术部位、术中出血量、术后是否发热及术后是否出现低氧血症两组间比较差异有统计学意义(P＜0.05);术后血红蛋白、红细胞比容两组间比较差异有统计学意义(P＜0.05).多因素logistic回归分析显示,年龄、手术时间及术后发热、低氧血症是术后谵妄产生的独立危险因素.结论 年龄、手术时间、术后发热、术后低氧血症是发生术后谵妄的独立危险因素,缩短手术时间、术后发热管理和避免低氧血症可能会减少术后谵妄的患病率.

Rationale: The establishment of lung isolation is often particularly challenging for the anesthesiologist in patients with difficult airway. Usually, orotracheal intubation with double lumen tube is the commonly used technique for achieving 1 lung anesthesia. Whereas, in patients with limited mouth opening and restricted cervical mobility, this technique becomes extremely difficult and hazardous. We report a case in which bronchial blocker placement was succeeded via both nostrils in a difficult airway due to restricted mouth opening. Patient concerns: A 50-year-old, non-smoking female with a painless mass in the left upper lobe. She had a 10-year history of ankylosing spondylitis and squamous cell carcinoma of the floor of the mouth after 5 operations 4 years previously. Diagnoses: Left upper lobe adenocarcinoma, ankylosing spondylitis and oral squamous cell carcinoma. Interventions: To achieve 1 lung anesthesia, both nostrils were used for extraluminal bronchial blocker placement. Outcomes: Initially, oral intubation was selected for establishing a patent airway but failed. Then switched to nasal canal for insertion, after several attempts, a conventional nasal intubation tube (internal diameter 6.0mm) was placed via 1 nostril under topical anesthesia, with the aid of a flexible fiberoptic bronchoscope, and a bronchial blocker was advanced to the desired position via the other nostril. Lessons: In difficult airway with limited mouth opening and restricted cervical mobility, multidisciplinary experts participated discussion is a prerequisite for contemplating a scientific plan. Preoperative computed tomography scan and 3-dimensional computed tomography reconstruction would be helpful in detecting the narrowest part of airway conduit and determining a safe, reliable, and feasible airway program. Abbreviations: CT= computed tomography, FOB = fiberoptic bronchoscope, ID = internal diameter.

背景:既往的相关研究主要集中研究退变性腰椎滑脱症和下腰痛与椎旁肌容量之间的关系,对于腰椎管狭窄症与椎旁肌的研究较少.目的:对比退变性腰椎滑脱症、椎管狭窄症患者和对照组之间椎旁肌、腰大肌横截面积的差异.方法:回顾分析在2017年1月至2018年8月同时行腹部或者腰椎CT和MRI扫描的90例女性患者的影像学资料,根据疾病类型分为3组,每组30例.A组为L4/5单一节段腰椎管狭窄症患者,B组为L4/5单一节段腰椎滑脱症患者,C组(对照组)为既往无腰椎相关疾病和症状的人群.所有患者对诊疗方案均知情同意,且得到医院伦理委员会批准.选取经过L3,4,5椎体下缘的轴位MRI图像测量肌肉横截面面积,选取经过L3,4,5双侧椎弓根下缘的椎体轴位图像测量椎体横截面积.使用Image-PRO Plus 6.0软件计算图像中目的肌肉和椎体的横截面积,并进行组间对比.结果与结论:①3组在年龄分布上差异无显著性意义(P=0.986);②腰大肌、椎旁肌横截面积:A组与B组差异无显著性意义(P>0.05),而A、B组均小于C组(P<0.001);③椎体横截面积:3组之间差异无显著性意义(P>0.05);④提示L4/5单一节段退变性腰椎管狭窄症和退变性腰椎滑脱症患者,在L3,L4,L5椎体下缘水平均可以观察到腰大肌横截面积及椎旁肌横截面积较对照组减少,且具有一致性,但二者在肌肉减少的机制上可能不完全相同.

Rationale: Intraspinal anesthesia, the most common anesthesia type of orthopedic operation, is regarded as safe and simple. Despite of the rare incidence, puncture related complication of intraspinal anesthesia is catastrophic for spinal cord. Here we present an intradural hematoma case triggered by improper anesthesia puncture. The principal reason of this tragedy was rooted in the neglect of spine deformities diagnosis before anesthesia. To the best of our knowledge, there is no specific case report focusing on the intradural hematoma triggered by improper anesthesia puncture. Patient concerns: Hereby a case of thoracolumbar spinal massive hematoma triggered by intraspinal anesthesia puncture was reported. The presenting complaint of the patient was little neurologic function improvement after surgery at 6-month follow-up. Diagnoses: Emergency MRI demonstrated that massive spindle-like intradural T2-weighted image hypointense signal masses from T12 to S2 badly compressed the dural sac ventrally, and his conus medullaris was at L3/4 intervertebral level with absence of L5 vertebral lamina. Hereby, the diagnoses were congenital spinal bifida, tethered cord syndrome, spine intradural hematoma, and paraplegia. Interventions: Urgent surgical interventions including laminectomy, spinal canal exploration hematoma removal, and pedicle fixation were performed. The patient received both medication (mannitol, mecobalamin, and steroids) and rehabilitation (neuromuscular electric stimulation, hyperbaric oxygen). Outcomes: Postoperation, he had regained only hip and knee flexion at II grade strength. His neurologic function was unchanged until 3 weeks postoperation. Six-month follow-up showed just little neurologic function improvement, and the American Spinal Injury Association grade was C. Lessons: By presenting an intradural hematoma case triggered by improper anesthesia puncture, we shared the treatment experience and discussed the potential mechanism of neurologic compromise. The principal reason for this tragedy is preanesthesia examination deficiency. Necessary radiology examinations must be performed to prevent misdiagnosis for spinal malformation.

颈椎前路手术目前主要包括减压植骨融合和内固定术（anterior cervical discectomy and fusion,ACDF）,次全切除术（anterior cervical corpectomy and fusion,ACCF）,人工椎间盘置换术（cervical disc arthroplasty,CDA）[1],随着术者对手术的熟练,对颈部解剖认识的加深以及手术器械等的改变,也使得前路手术可减压的范围以及手术的适应症较前扩大,也更多的应用在颈椎病的治疗上。与后路手术的间接减压相比,前路手术可有效恢复椎间高

The cause of scoliosis is complex and not fully understood.Animal model research has become an important way to explore the cause of scoliosis and even prevention and treatment methods.This review aims to summarize the latest progress in the animal models of scoliosis.

神经鞘瘤又称施旺细胞瘤,是椎管内常见的良性肿瘤之一,好发于硬膜内髓外和硬膜外。髓内神经鞘瘤十分少见,占椎管内神经鞘瘤的百分之一[1]。椎管内神经鞘瘤主要发生在腰骶段,其次胸段,最后颈段,若肿瘤体积大可累及椎间孔而成为哑铃状。本例腰椎管内神经鞘瘤瘤体巨大,现报道如下。1临床资料患者男性,26岁,因3个月前出现间歇性腰疼

Rationale: Traumatic nucleus pulposus sequestration (TNPS) usually occurs concurrently with severe destruction of bone. TNPS combined with a slight thoracolumbar flexion- distraction fracture, triggering a disastrous nerve injury, has rarely been reported. Due to the atypical radiologic manifestations, such a patient can easily be overlooked. Patient concerns: Hereby, we present a TNPS patient as well as a slight thoracolumbar flexion-distraction fracture and serious neurologic symptoms. Diagnoses: T12 spinous process fracture, L1 flexion distraction fracture, thoracolumbar traumatic nucleus pulposuse sequestration and lower limbs incomplete paralysis Interventions: To avoid further neurologic compromise, an urgent laminectomy and exploration of the spinal canal was performed. Outcomes: After decompression OR and 4 months rehabilitation, the patient's neurologic function improved remarkably. Lessons: A slight flexion-distraction fracture following injury is liable to eclipse the concurrence of TPNS. For this patient, a high-resolution MRI was needed to make a definitive diagnosis and guide surgery. Once TPNS has been diagnosed, sufficient decompression and discectomy surgery should be performed without delay.

Objective: To explore the clinical effectiveness of various posterior decompression surgeries in the treatment of upper thoracic spinal stenosis combined with multilevel cervical spinal stenosis. Methods: From January 2010 to December 2015, 22 consecutive patients with combined upper thoracic spinal stenosis and multilevel cervical spinal stenosis were treated with two different approaches of posterior decompression surgeries. In group A with 10 patients, both cervical and thoracic spinal decompression surgeries were performed simultaneously (one-stage surgery); in group B with 8 patients, cervical and thoracic spinal decompression surgeries were performed separately within three months (two-stage surgery). Based on Japanese Orthopedic Association (JOA) scores, improvement rate and extent of neurological function were calculated and the difference was compared between the two groups. Results: There was no significant difference in demographic data between the two groups. However, compared with those of group B, both short-term and long-term improvement rate of neurological function in group A was higher (P < 0.05). In addition, the hospitalization cost was also lower in group A. Conclusion: Both one-stage and two-stage posterior decompression surgeries were effective in treating patient with upper thoracic spinal stenosis combined with multilevel cervical spinal stenosis; however, one-stage combined surgery was superior to two-stage surgery.

下肢静脉血栓尤其是深静脉血栓形成（DVT）是一种常见的多发于下肢血管的血液回流障碍性疾病,起病急,进展快,可导致肺栓塞发生,严重危及患者生命安全。骨科手术是引起下肢静脉血栓众所周知的危险因素[1]。临床上常规检查下肢静脉血栓的方法是彩色多普勒超声检查,但其无法预测下肢静脉血栓的发生发展。血浆D-dimer是纤维蛋白水解

RATIONALE:Tertiary syphilis can manifest as gummatous disease, but gumma of the spine has been extremely rarely reported.PATIENT CONCERNS:A 61-year-old male complained of worsening pain and numbness in both lower legs for four weeks.DIAGNOSES:Syphilis of the Lumbar Spine.INTERVENTIONS:Pedicle screw fixation (L3-S1) and posterior decompression of the vertebral canal at L4-5 were performed.OUTCOMES:The postoperative VAS score of both lower extremities decline to 2 from 7 at admission. Dorsal thumb extensor motor power (left/right) at day 7 postoperatively was 3/3 (versus admission: 1/1). Laboratory examinations showed normal white blood cell count (versus admission: 13.8 × 10/L; reference value: 4.00-10.00 × 10/L) and decline in C-reactive protein (20.35 mg/L versus admission: 77.43 mg/L; reference value: 0.00-10.00 mg/mL) and ESR (58 mm versus admission: 73 mm; reference value: 0-15 mm).LESSONS:Our case illustrates that although gummatous disease of the spine may be extremely rare, it should be considered in the differential diagnosis of tuberculosis or malignancy of the spine so as to avoid a wrong diagnosis and incorrect treatment.

Objective To study the bone stress change after implanting two different interbody fusion cages at L4-5 intervertebral body, and to provide the parameters for clinical use and cage design. Methods The specimens were obtained from healthy 8-month-old adult male calves. We used them to simulate disc herniation anteriorly at L4-5 intervertebral space. These specimens were randomly divided into two groups: a wedge-shaped fusion group and a cylindrical fusion group. The resistance strains were bonded to the relevant parts of the specimens, and then wires were welded and locations were marked. Subsequently, bending momen?tum (200N-CM) was applied and the strain value was measured at each moment. Finally, the data were analysed by SPSS 19 software, and the difference between the two groups were compared using paired t test. Results The maximum strain is was located at L5 anterior margin (A measurement), which was mainly due to slotting at the L4-5 vertebra clearance for interbody fusion cage implantation, and closing to the implanting site. The mini?mum strain was located at the L4 vertebral articular process (F measurement), which was due to being far away from the implanting site. The values of left bending of F measurement were 217.25±13.87 με×10-6 (wedge bone group) and 286.25 ± 4.86 με× 10-6 (cylindrical bone group) respectively, and the values of lateral bending are were-253.75 ± 6.08 με× 10-6 (wedge bone group) and-305.75 ± 8.02 με× 10-6 (cylindrical bone). Conclusion A larger stress change occurred at L5 anterior margin under the lateral bending stress after implantation of inter?vertebral fusion device. The stress change of wedge-shaped fusion group is less than that of the cylindrical fu?sion group.

Rationale: Tertiary syphilis can manifest as gummatous disease, but gumma of the spine has been extremely rarely reported. Patient concerns: A 61-year-old male complained of worsening pain and numbness in both lower legs for four weeks. Diagnoses: Syphilis of the Lumbar Spine. Interventions: Pedicle screw fixation (L3-S1) and posterior decompression of the vertebral canal at L4-5 were performed. Outcomes: The postoperative VAS score of both lower extremities decline to 2 from 7 at admission. Dorsal thumb extensor motor power (left/right) at day 7 postoperatively was 3/3 (versus admission: 1/1). Laboratory examinations showed normal white blood cell count (versus admission: 13.8 × 109/L; reference value: 4.00−10.00 × 109/L) and decline in C-reactive protein (20.35 mg/L versus admission: 77.43 mg/L; reference value: 0.00−10.00 mg/mL) and ESR (58 mm versus admission: 73 mm; reference value: 0–15 mm). Lessons: Our case illustrates that although gummatous disease of the spine may be extremely rare, it should be considered in the differential diagnosis of tuberculosis or malignancy of the spine so as to avoid a wrong diagnosis and incorrect treatment.

近年来,再生相关基因(RAGs)以及表观遗传修饰对轴突再生的调控作用逐渐成为领域内的研究热点 [1] 。我们在体内转染技术的基础上建立了绿色荧光蛋白(GFP)/目的基因质粒共转染的脊髓背根神经节(DRG)轴突示踪动物模型。一、材料与方法1.实验材料与分组:成年雌性C57BL/6小鼠(8 1 0周龄,30 3 5 g,购于北京维通利华公司,动物饲养于吉林大学中日联谊医院科研中心,所有实验操作及内容均经实验动物伦理委员会审查及批准);磷酸盐缓冲液(Gibco公司);青/链霉素双抗(Gibco公司);戊巴比妥钠粉剂(Sigma公司;4%多聚甲醛(Sigma公司);质粒提取试剂盒(Life Tech公司);Tubulin-Ⅲ、

Monteggia's fracture is a common injury in children,but it tends to develop into the old fracture due to missed diagnosis,which not only affects the growth and function of the patients' elbow joint and forearm,but also increases the difficulty of treatment.Standard forearm X-ray can help prevent missed diagnosis of Monteggia's fracture in children.This article summarizes the current diagnosis and treatment of old Monteggia's fracture in children.

自发性椎管内硬膜外血肿（spontaneous spinal epidural hematoma,SSEH）指病因不明、非医源性和创伤因素所致的血液在椎管内硬膜外腔非特异性聚集。临床罕见,多进展迅速,常因对该病认识不足而延误治疗,出现严重的神经功能障碍,预后较差,甚至出现神经功能的永久性损伤[1]。我院收治1例自发性胸腰段硬膜外血肿患者,报道如下。1临床资料患者男,65岁,因"腰背部疼痛伴双下肢无力4

目的 探讨Salter骨盆截骨术治疗小儿发育性髋关节脱位的临床效果. 方法 回顾性分析2012年1月～2014年3月采用切开复位、Salter骨盆截骨术治疗的38例(45髋)发育性髋关节脱位患儿临床资料,其中男7例,女31例;平均年龄26.1(18 ～38)个月;右髋14例,左髋17例,双髋7例.脱位程度按Tonnis分级:Ⅱ度18髋,Ⅲ度19髋,Ⅳ度8髋.行Salter骨盆、切开复位37髋;联合股骨近端短缩旋转截骨术8髋.测量髂臼指数(acetabular index,AI)、CE角(center-edge angle,CEA),术后分别按Severin影像学评级标准和Mc Kay功能评级标准进行疗效评定. 结果 术后平均随访21.4(12～36)个月.术后AI平均23.7°±5.2°,CEA平均30.1°±4.7°,较术前获得明显改善(P＜0.01).术后Severin标准评价:优28髋(62.2％),良13髋(28.9％),可4髋(8.9％),优良率91.1％;Mc Kay标准评级:优26髋(57.8％),良16髋(35.6％),可3髋(6.6％),优良率93.3％.Severin标准影像学评级与Mc Kay功能评级之间存在正相关(r=0.92,P＜0.01). 结论 Salter骨盆截骨术治疗小儿发育性髋关节脱位可取得满意效果,值得临床推广.