目的 探讨颈前路混合减压融合术治疗多节段脊髓型颈椎病的中期临床效果及其并发症分析.方法 回顾性分析2013年9月至2017年10月,行颈前路混合减压融合手术治疗的多节段脊髓型颈椎病36例患者资料,男21例,女15例,年龄43～71岁,平均为(52.8±2.7)岁,对所有患者进行随访,采用疼痛视觉模拟评分(VAS)评估颈肩肢体疼痛情况,日本骨科协会(JOA)评分评估患者神经功能恢复情况,生活质量评价量表(SF-36)整体评价患者手术疗效,行颈椎正侧位及过伸过屈位X线片,观察钛网等内固定情况,测量颈椎高度和颈椎生理曲度,评估植骨融合情况.并记录患者手术相关并发症.结果 34例患者获得随访,随访时间为36～72个月,平均随访时间为(50.8±4.1)个月.术前VAS为(6.9±2.2)分,高于末次随访时的(1.7±0.4)分(P＜0.001).术前JOA评分为(6.7±2.4)分,低于末次随访时的(14.8±3.6)分(P＜0.001).末次随访SF-36评分为(68.2±1.7)分,高于术前的(31.9±3.3)分(P＜0.001).至末次随访时,患者颈椎椎体高度及颈椎曲度较术前均有明显改善(P＜0.001).2例患者出现内固定松动、移位,融合率为94.1％,邻近节段退变6例,螺钉断裂1例.结论 颈前路混合减压融合手术治疗多节段脊髓型颈椎病,能有效恢复颈椎高度和维持颈椎曲度,是治疗多节段脊髓型颈椎病较为理想的手术方式之一.

目的:探讨颈前路手术治疗4个节段脊髓型颈椎病的中期临床效果及其并发症分析.方法:回顾性分析2013年9月～2016年10月,行颈椎前路手术治疗的4个节段脊髓型颈椎病31例患者资料,男18例,女13例,年龄54 ～74岁,平均58.1±4.9岁,对所有患者进行随访,采用疼痛视觉模拟评分(visual analogue scale,VAS)评估颈肩肢体疼痛情况,日本骨科协会(Japanese Orthopedic Association,JOA)评分评估患者神经功能恢复情况,行颈椎正侧位及过伸过屈位X线片,观察钛网等内固定情况,测量C2～C7颈椎椎体高度和颈椎生理曲度,评估植骨融合情况.并记录患者手术相关并发症.结果:27例患者获得随访,随访时间为35～72个月,平均52.7±3.6个月.末次随访时VAS为1.6±0.6分,低于术前的7.2±1.5分,差异有统计学意义(P＜0.001).末次随访JOA评分为16.1±4.2分,高于术前的8.8±3.7分,差异有统计学意义(P＜0.001).至末次随访时,患者颈椎椎体高度及颈椎曲度较术前均有明显改善,差异有统计学意义(P＜0.001).所有患者均获得骨性融合,27例患者共出现19例次并发症,脑脊液漏3例,一过性吞咽困难2例,轴性症状1例,C5神经根麻痹2例,邻近节段退变6例,钛网下沉2例,内固定松动、移位2例,螺钉断裂1例.结论:颈前路手术治疗脊髓前方受压为主的4个节段脊髓型颈椎病,能有效恢复颈椎高度和维持颈椎曲度,其中期疗效满意.

Objective To investigate the clinical results, neurological scores, radiographic changes and complications for patients with 4-level cervical spondylotic myelopathy (4-level CSM) who underwent anterior decompression and fusion surgery.Methods All the medical records of anterior cervical surgery in our hospital between September 2006 and March 2014 were collected.Among them, thirty-two consecutive patients with 4-level CSM underwent the anterior decompression and fusion procedures were retrospectively investigated.Neurological function was measured at different times using Japanese Orthopedic Association (JOA) scores.The visual analogue score (VAS) was recorded for neck-shoulder pain evaluation.X-rays were conducted before and after surgery for cervical lordosis and fusion rate.Complications such as iliac pain, dysphonia, C5 palsy, cerebral fluid leakage, axial neck pain and temporary dysphagia were recorded and analyzed as well.Results All the operations were performed uneventfully.The mean operative time was 136± 18min and mean blood loss was 67±16ml.The overall follow-up period of the patients ranged from 1-8 years (average 3.6± 1.7years).The VAS score significantly decreased from 7.3± 1.2 preoperatively to 3.6±0.8 at 12 months postoperatively.The JOA score was 9.2± 1.6 preoperatively, and 9.6±2.2, 12.5±3.3, 13.2±3.2, 13.7±3.4 at 1 week, 3 months, 6 months and 12 months postoperatively.Autologous iliac bone grafts were used in 4 patients, whose fusion rate was 100％ at 6 months postoperatively.Titanium meshes were used in 28 patients, whose fusion rate was 85.7％ at 6 months postoperatively and 100％ at 12 months postoperatively.No hardware-related complications such as screw pull-out or plate bending occurred during the short-or long-term follow-up.Complications included iliac pain (3 cases), dysphonia (1 case), C5 palsy (1 case), cerebral fluid leakage (2 cases), axial neck pain (5 cases) and temporary dysphagia (1 case).Conclusion Anterior approach for 4 -level CSM is a challenging surgical technique.The choice of corpectomy levels should depend on the characteristics of cord compression.C4 and C6 discontinuous corpectomy with titanium mesh graft fusion and plate fixation is recommended procedure.This technique will be safe and effective if proper decompression and steady fixation are guaranteed.

痛风是现代社会较为常见的代谢性疾病.当高尿酸血症持续存在,尿酸盐结晶形成并沉积,即形可成痛风石.痛风石常见于足(足母)跖趾关节背侧,肘后、耳廓、足跟、膝前也很常见,但出现在椎管内者罕见.我院2014年10月收治1例胸椎管内痛风石导致脊髓压迫症的患者,经手术治疗取得了良好效果,报告如下.

血管周细胞瘤(HPC)又称血管外皮细胞瘤,是一种罕见的源于软组织血管外皮细胞或未分化的间质细胞且具有侵袭性的中间型肿瘤.HPC可发生于身体任何部位,以深部软组织多见,神经系统的HPC较为少见,而源于椎管内的HPC更为罕见.我院于2014年11月收治了1例T4～T7范围椎管内HPC导致脊髓压迫症的患者,经手术治疗取得良好效果,报告如下.

<正>患者男,55岁,2010年11月14日因"小便泡沫增多2周"入院。患者于入院前2周始自觉小便泡沫增多,无尿频尿急尿痛,无尿量减少,无腹痛腹泻,无畏寒发热,有双下肢凹陷性水肿。门诊查尿蛋白(+++),隐血(++)。既往有高血压病史,长期服用"坎地沙坦"4mg1次/d,体重70kg。入院检查:体温36.0℃,脉搏94次/min,呼吸16次/min,血压164/100

Objective To study the effect of visual analogue pain score(VAS) and analgesic on spinal myeloma diagnosis and the reasons of spinal myeloma delayed diagnosis.Methods Reviewing the clinical data of 28 patients diagnosed multiple myeloma(MM) admitting diagnosis,and laboratory diagnosis.Another 28 patients were chosen as the control group,according to certain selection criteria,matching with the multiple myeloma patients.VAS score and analgesic dosage of both the MM group and the control group were recorded.Comparisons were made between the two groups.Results The VAS scores and analgesic drug have statistical differences between the two groups.Of the 28 patients,the false negative rates were,46.4%,21.4%and 3.6%of urinary Bence-Jones protein,serum protein electrophoresis and ESR,respectively.Insufficient attention and carelessness are the main causes of delayed diagnosis.Conclusion VAS score and analgesic drug are beneficial to diagnosing spinal multiple myeloma.

OBJECTIVE:To discuss diagnosis and treatment of iatrogenic purulent lumbar spinal infection.METHODS:From December 2006 to January 2010, 4 patients with iatrogenic purulent lumbar spinal infection were treated with posterior debridement. There were 2 males and 2 females, ranging in age from 50 to 66 years (respectively in 52, 66, 58, 50 years); in course of disease from 2 weeks to 2.5 months (respectively in 21, 14, 60, 75 days ). All patients had fever, lumbago, local tenderness and limited lumbar activity before operation. White blood cell count (WBC), erythrocyte sedimentation rate (ESR) were abnormal. The clinical effects were evaluated by symptoms and laboratory examination.RESULTS:Symptoms of lumbago and fever vanished in 4 patients, of which wounds were primary healing without complications. The patients were followed up for 3 months, no infection (WBC, C-reactive protein and ESR were normal) and lumbar instability were found.CONCLUSION:Iatrogenic purulent lumbar spinal infection can be diagnosed according to course of disease, clinical symptoms and signs, imaging finding. In the items, magnetic resonance imaging finding have necessarily specificity, once finding abscess-formation, will promptly operate.

Background Trans‐sacral axial L5/S1 interbody fusion (AxiaLIF), a novel surgical procedure, recently adopted in clinical practice, has excellent clinical outcomes. However, there is inadequate data on the feasibility of the approach in all adult patients and the optimal surgical approach is currently unclear; therefore, further studies are required. In order to enhance the surgical approach for AxiaLIF, prospective anatomical imaging optimization is necessary. The objective of this study was to investigate the ability of magnetic resonance imaging (MRI) to achieve an optimal procedural setting. Methods The subjects (n=40) underwent lumbosacral MRI examination. The median sagittal MRI images were analyzed and four measurement markers were defined as follows: the center of the L5/S1 disc (A), the anterior margin of the S1/2 disc space (B), the sacrococcygeal junction (C), and the coccygeal tip (D). The measurement markers were connected to each other to produce five lines (AB, AC, AD, BC, and BD), as reference lines for surgical approaches. The distance between each reference line and the anterior and posterior margins of the L5 and S1 vertebral bodies was measured to determine the safety of the respective approaches. Results In all patients, Lines AB and AC satisfied the imaging safety criteria. Line AB would result in a significant deviation from the median and was determined to be unsuitable for AxiaLIF. Line AD satisfied the imaging safety criteria in 39 patients. However, the anal proximity of the puncture point proved to be limiting. For lines BC and BD, the imaging safety criteria were satisfied in 70% and 45% of patients, respectively. Conclusions The AxiaLIF procedure is a safe technique for insertion of fusion implants in all subjects. Line AC is a favorable reference line for surgical approach and safe for all subjects, while line BC is not suitable for all subjects.

椎体间轴向融合术(Axial lumbar interbody fusion,Axia LIF)是近年来新出现的一种融合技术.该术式突破了传统的后方和前方入路,创造性的提出骶骨前入路.

Objective To evaluate the outcomes of bone mesenchymal stem cells(BMSCs) entrapped in alginate bead in repairing the degenerative disc.Methods The rabbit models of degenerative intervertebral disc were established by nucleus aspiration and were divided into control group,blank group and treatment groups.Encapsulated in alginate beads,BMSCs were transplanted into the degenerative discs in the treatment group;animals in the control group only received alginate beads,and those in the blank group received no treatment.The repairing effects on the degenerative discs were determined by MRI,immunohistochemical and biochemical analysis in the 3 groups.Results Degeneration of lumbar discs occurred in 3 groups 2,4,8 and 12 weeks after operation;while 12 weeks after operation,the degeneration in the treatment group was significantly slighter than those in the control group and blank group(both P<0.05).Twelve weeks later,the contents of proteoglycan were(4.982±0.458),(5.318±0.602) and(6.487±0.609) mg/100 mg in the blank group,control group and treatment group,respectively.The proteoglycan levels in the treatment group were significantly higher than those in the control group and blank group(both P<0.05).The contents of type Ⅱ collagen were 150.669±2.387,149.849±2.48 and 141.680±1.618 in the blank group,control group and treatment group,respectively.The type Ⅱ collagen level in the treatment group were significantly higher than that in the control group and blank group(both P<0.05).Conclusion Alginate scaffold combined with BMSCs may be useful for repairing the degeneration disc,which may serve a biological method for repair of degraded discs

[目的]探讨椎管内血管脂肪瘤的临床特性。[方法]报道9例椎管内血管脂肪瘤的临床资料并回顾文献。[结果]9例患者经外科切除肿瘤后预后良好。[结论]诊断主要以磁共振为依据。治疗以外科切除为主,不论是否浸润,预后良好。

Objective: To study the effect of bone mesenchymal stem cell (BMSC) transferred by hBMP-7 gene on proteoglycan of degenerative intervertebral disc of rabbits. Methods: Models of degenerative intervertebral disc were established on 20 rabbits and the animals were randomly divided into two groups. For study groups, BMSC transferred by adenovirus vector mediated hBMP-7 gene was injected into degenerative intervertebral disc; for control groups, PBS was injected into the same intervertebral disc. The changes of the intervertebral disc was showed by MRI, and the proteoglycan was quantitated by spectrophotometer to observe the repair effect. The hBMP-7 expression was detected by immunohistochemistry and RT-PCR in vivo. Results: The MRI T2 value and the content of proteoglycan of study groups had significant difference comparing with that of control grup(P0.05), as well the expression level of hBMP-7 mRNA and protein. Conclusions: BMSC transferred by adenovirus vector mediated hBMP-7 gene are helpful for improving the expression of proteoglycan in nucleus pulposus after injecting into degenerative intervertebral disc of rabbits.

Porosity and pore size of biomaterials play a critical role in bone formation.Higher porosity and pore size result in greater bone ingrowth but diminish mechanical properties.Thus,a balance must be reached depending on the mechanical properties and bone ingrowth of the biomaterials.New fabrication techniques,such as solid-free form fabrication,can potentially be used to generate materials with selectively designed morphological and mechanical properties to meet the specificity of bone repair.This review explored the in vitro and in vivo studies regarding the influence of porosity and pore size for a material on the bone ingrowth.

Objective To study the risk factors and precautions of spinal epidural hematoma(SEH)follow anterior cervical corpectomy.Methods From February 2000 and September 2006.1 752 patients were treated with anterior eervical corpectomy in our institution.There were 4 cases suffered SEH postoperatively,including 2 males,2 females,with the mean age 48.5 years(ranged from 42 to 56 years).All patients were eervicle myelopathy,and the mean preoperative cervicle function was 8.75(ranged from 6 to 1 3)according JOA score system.To review and analyze with regard to occurrence and duration hours of symptoms,main clinical manifestation,and the effect of hematoma evacuation on patients'neurologic function recovery.Results 4 patients were identified with having SEH after anterior cervical corpectomy.The incidence of SEH was 0.23%.Mean interval between onset of symptoms and surgery was 5 hours(range,2-9 hours).Operative treatment was accomplished in all cases by incision exploration and hematoma evacuation.All patients were followed up 18-22 months fmean 20 months).No recurrence was found.There was significant im-provement in all patients after reoperation except one who only had partial improvement on the upper extremities and left over bladder dysfunction.Conclusion Diagnosis is highly depending on clinical findings for MR would cost critical time and delay reoperation.Intensive care in 24 hr postoperatively iS also important because SEH often OCCURS in this period.Prophylaxis iS predominant to SEH and surgical evacuation should be performed once SEH is identified.The less duration hours of symptoms,the better neurologic function recovery.

> 患者男,22岁,学生。左下肢疼痛、不适2个多月,以腰椎间盘突出症入院。查体:腰部生理性前凸变平,L 4.5 棘突左侧压痛。双下肢肌力5级,双足（?）背伸、跖屈肌肌力5级。双下肢感觉正常,双膝腱反射、右跟腱反射正常,左跟腱反射减弱。双 Babinski 征阴性,左直腿抬高试验30°,加强试验阳性;右直腿抬高试验阴性。会阴区感觉正常。实验室检查未见异常。腰椎 MRI 显示 L 4-5 椎间盘突出,突出的椎间盘 T 2 加权像呈低信号.T 1 加权像呈中等信号。突出的椎间盘下方有椭圆形囊性软组织影,T 2 加权像呈高信号,T-1加权像呈中等信号（图1,2）。横断面 T 2 加权像见高信号的软组织影位于突出椎间盘的背侧（图3）。

自2000年美国《科学》杂志首次报道来源于骨髓的细胞进入脑并表达神经表型以来,在动物模型上进行的骨髓基质细胞移植模拟治疗中风、脊髓损伤、肌萎缩性侧索硬化及帕金森病等的研究均显示有一定的疗效。近年来体外诱导骨髓基质细胞向神经系细胞分化的研究颇多,其中涉及到多种生物技术。该文就化合物诱导及潜在问题、蛋白及基因转染问题、骨髓基质细胞与神经细胞共培养等研究作一综述。