Decompression via posterior-anterior approach and anterior fixation in treatment of fracturedislocation of the lower cervical spine with bilateral facet joints dislocation

Objective To evaluate surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of lower cervical spine with bilateral facet joints dislocation. Methods This

Innervation of cervical ventral facet joint capsule: Histological evidence

AIM: To assess the presence of nerves in ventral facet joint capsules as facet capsules are generally implicated in neck pain.METHODS: Twenty-four ventral cervical facet joint capsules were harvested from 3 unembalmed cadavers. Paraffin sections from these capsules were processed to identify neurofilament and substance P immunoreactive fibers. Nerve fiber presence was also verified by a silver impregnation method.RESULTS: Neurofilament reactive fibers were observed in sections from 9 capsules. They were observed in areas with collagen fibers and areas with irregular connective tissue. Substance P reactive nerve fibers were found in sections from 7 capsules in similar areas. Silver impregnation also revealed the presence of nerve fibers. The nerve fibers were also found as bundles in the lateral margins of the capsule. A Pacinian corpuscle-like ending was also observed in onespecimen.CONCLUSION: Nerve fibers revealed by neurofilament immunoreactivity and silver staining support innervation of the ventral aspect of the facet joint capsule. The presence of substance P reactive fibers supports the potential role of these elements in mediating pain. The presence of a Pacinian-like ending implicates a potential role in joint movement.

Minimally Invasive Widening of the Facet Joints in Cervical Radiculopathy by Modified Needles： Technical Report

Surgical treatment and ESI （epidural steroid injection） are widely used forms of treatment for cervical radiculopathy but they are controversial and burdensome for patients. To relief pain fast without side effects, we devised a new minimally invasive treatment method that widens the facet joints to decompress nerve roots and release the muscle spasm in cervical radiculopathy with acupuncture needles with blunt tip and mini-scalpel, and named it modified acupuncture procedure. MAP （Modified acupuncture procedure） was administered for 37 patients （mean age = 53.1 years, follow-up = 14.2 months） with cervical radiculopathy who did not recover from 4 weeks of nonsurgical treatment. We analyzed clinical outcomes of patients before and after the procedure through VAS （Visual Analogue Scale） and NDI （Neck Disability Index）. On average, patients received 1.4 MAP （modified acupuncture procedures）. The VAS score difference on the day after procedure and at 1 year follow-up was 36.8 ± 26.5 （from 60.1 ± 25.3 at the baseline to 25.3 ± 17.8 at the reading） （P 〈 0.01） and 31.0 ± 30.4 （29.0 ± 21.8 at the reading） respectively. The NDI value dropped by 19.9 ± 18.3 （from 37.2 ± 19.7 at the baseline to 17.2 ± 15.0 at the reading） （P〈 0.01） on 1 year follow up. MAP was found to have clinical efficacy for cervical radiculopathy.

Interventional pain therapy in cervical post-surgery syndrome

Fifteen percent to forty percent of patients present with persistent disabling neck pain or radicular pain after cervical spine surgery. Persistent pain after cervical surgery is called cervical post-surgery syndrome(CPSS). This review investigates the literature about interventional pain therapy for these patients. Because different interventions with different anatomical targets exist, it is important to find the possible pain source. There has to be a distinction between radicular symptoms(radicular pain or radiculopathy) or axial pain(neck pain) and between persistent pain and a new onset of pain after surgery. In the case of radicular symptoms, inadequate decompression or nerve root adherence because of perineural scarring are possible pain causes. Multiple structures in the cervical spine are able to cause neck pain. Hereby, the type of surgery and also the number of segments treated is relevant. After fusion surgery, the so-called adjacent level syndrome is a possible pain source. After arthroplasty, the load of the facet joints in the index segment increases and can cause pain. Further, degenerative alterations progress. In general, two fundamentally different therapeutic approaches for interventional pain therapy for the cervical spine exist: Treatment of facet joint pain with radiofrequency denervation or facet nerve blocks, and epidural injections either via a transforaminal or via an interlaminar approach. The literature about interventions in CPSS is limited to single studies with a small number of patients. However, some evidence exists for these procedures. Interventional pain therapies are eligible as a target-specific therapy option. However, the risk of theses procedures(especially transforaminal epidural injections) must be weighed against the benefit.

麦肯基运动疗法联合颈椎关节松动术与耳穴压豆治疗颈型颈椎病临床效果

目的:探讨麦肯基运动疗法联合颈椎关节松动术与耳穴压豆治疗颈型颈椎病临床效果。方法:将广州医科大学附属第六人民医院2021年1月—2022年8月门诊及住院部接收的颈型颈椎病患者160例作为研究对象,采用随机数字表法将其分为对照组与研究组,每组80例。对照组采用麦肯基运动疗法,研究组采用麦肯基运动疗法联合颈椎关节松动术与耳穴压豆治疗,两组均持续治疗3个月。采用颈椎功能障碍指数(NDI)、疼痛灾难化量表(PCS)评价颈功能、疼痛程度。比较两组颈椎活动范围、凝视稳定性(GS)测试阳性率、眼动测试(EMT)阳性率。结果:治疗后,研究组NDI评分低于对照组,差异有统计学意义(P<0.05)。治疗后,研究组PCS评分的疼痛反复思虑、疼痛无助感、疼痛夸大维度得分及总分均低于对照组,差异均有统计学意义(P<0.05)。治疗后,研究组颈椎前屈、后伸、左右侧屈、左右旋转活动范围均高于对照组,差异均有统计学意义(P<0.05)。治疗后,研究组GS阳性率、EMT阳性率均低于对照组,差异均有统计学意义(P<0.05)。结论:麦肯基运动疗法联合颈椎关节松动术与耳穴压豆治疗颈型颈椎病,可有效恢复颈椎功能,减轻疼痛,增加颈椎活动范围,改善颈椎神经的协调性和稳定性。

“筋骨并举”推拿联合刃针治疗椎动脉型颈椎病引发睡眠障碍的临床疗效观察

目的:探究“筋骨并举”推拿联合刃针针刺干预椎动脉型颈椎病所引发睡眠障碍的临床疗效。方法:选取符合标准的60例椎动脉型颈椎病引发睡眠障碍的患者,分为对照组30例和观察组30例。对照组为刃针针刺治疗,观察组为“筋骨并举”推拿联合刃针针刺治疗。分别于治疗开始前、治疗疗程完成后,分析比较2组患者匹兹堡睡眠质量指数评分(PSQI)、视觉模拟评分(VAS)、疗效评估及1月后随访复发情况。结果:在接受治疗后,对2组患者PSQI及VAS评分进行的组内比较各项得分变化情况均优于治疗前(P<0.05);组间比较,观察组与对照组得分差异具有一定统计学意义(P<0.05)。疗程完成后,观察组总有效率(93.33%)相较于对照组总有效率(76.67%)高;自治疗结束次日起1月后随访发现,观察组复发率相较于对照组低,且P<0.05。结论:“筋骨并举”推拿联合刃针疗法能够改善椎动脉型颈椎病患者的相关临床症状,且可以有效提高患者睡眠质量,降低复发率。

Neuromyelitis Optica Spectrum Disorder Associated with Cervical Spondylosis

Neuromyelitis optica spectrum disease （NMOSD） refers to a group of related disease, in which potential pathogenesis is similar to neuromyelitis optica （NMO）, but clinical involvement does not exactly correspond to the diagnosis of NMO. Owing to varied clinical manifestations, it is apt to be misdiagnosed. We report a case of NMOSD with cervical spondylosis and discuss the experience of diagnosis.

基于“以筋为先”理论运用仰卧位动态旋牵法论治颈椎小关节紊乱症

本文介绍一种临床治疗颈椎小关节紊乱症的改良整复手法,针对颈椎小关节紊乱症的核心病机“筋骨失衡”,运用“以筋为先”理论进行论治。颈椎小关节紊乱症病因根据筋骨损伤的先后可分为“骨先不正致筋不柔”与“筋先不柔致骨不正”两种情况,其中“筋不柔”是颈椎小关节紊乱症首先和首要解决的问题。基于此,仰卧位动态旋牵法从颈部筋骨关系角度出发,注重筋结构和功能的恢复,能够柔和有效地调整颈椎小关节紊乱状态。该手法操作简单、安全性高,对于治疗颈椎小关节紊乱症疗效显著,同时其易学易练的特点还能为推拿初学者全面掌握推拿整复类手法打下基础。

内镜下单侧小关节分级切除对颈椎节段稳定性影响

目的 探究颈椎内镜下不同范围小关节切除对颈椎节段稳定性的影响,为临床手术提供生物力学理论基础。方法 基于CT数据建立颈椎C5~6正常有限元模型,并模拟颈椎内镜手术操作获得不同范围(0、25%、50%、75%、100%)单侧小关节切除椎板开窗模型(模型1~5),分析比较各组模型节段活动度(range of motion, ROM)及椎间盘von Mises应力情况。结果 除前屈工况外,模型1、2较正常模型各方向下ROM及椎间盘von Mises应力改变不明显,模型3较正常模型各方向下ROM及椎间盘von Mises应力出现较为明显增加,前屈、后伸、左侧弯、右侧弯、左旋转及右旋转时ROM分别增加27%、4%、3%、13%、5%、16%,von Mises应力分别增加32%、4%、2%、5%、9%、5%。模型4、5较正常模型各方向下ROM及椎间盘von Mises应力增加显著,模型4的ROM分别增加27%、14%、6%、24%、7%、167%,von Mises应力分别增加33%、13%、3%、32%、10%、130%;模型5的ROM分别增加27%、17%、6%、25%、7%、167%,von Mises应力分别增加33%、29%、8%、33%、12%、138%。结论 随着单侧小关节切除范围的增加,颈椎节段ROM和椎间盘von Mises应力极值逐渐增加。当单侧小关节切除超过1/2时,颈椎出现较大的ROM增加及应力改变。临床手术中应尽量保留1/2以上颈椎小关节,避免医源性失稳。

下颈椎关节突三维参数测量与关节突螺钉导向器的设计

背景:近年来,颈椎关节突关节在颈椎病的发病机制和外科治疗中逐渐被重视,但是目前关于成人下颈椎关节突关节的解剖学研究相对较少。目的:测量下颈椎关节突三维参数,为下颈椎经关节突螺钉导向器的设计提供依据。方法:选取2021年6月至2022年6月于徐州医科大学附属医院行颈椎CT检查人员100例,男50例,女50例,年龄20-50岁。经筛选每例图像均无颈椎椎管狭窄、颈椎椎间盘突出、明显的骨质增生、感染及肿瘤等病变。经过三维重建后,测量C_(3-7)每个节段颈椎关节突关节矢状面上的倾斜角和矢状面下颈椎经关节突螺钉与关节突关节面的夹角。根据统计分析测量结果,利用CAD软件设计出下颈椎经关节突螺钉导向器。结果与结论:矢状面颈椎关节突关节面倾斜角以C5为中心呈U形分布,大小关系为C_(7)>C_(6)>C_(3)>C_(4)>C_(5);矢状面上经关节突螺钉角度大小关系为:C_(6/7)>C_(5/6)>C_(4/5)>C_(3/4),其中C_(3/4)、C_(4/5)、C_(5/6)角度均接近90°,C_(6/7)角度超过100°。通过测量矢状面颈椎关节突关节面倾斜角和经关节突螺钉角度,设计出了矢状面垂直于关节突关节面的导向器。

13-18岁青少年颈椎关节突关节发育特征的数字化三维形态分析

背景:颈椎关节突关节作为颈椎后柱的重要解剖结构,在颈部活动、应力传导以及维持颈椎稳定性中发挥重要的作用。近年来通过解剖学和生物力学研究表明,颈椎关节突关节不对称可引起关节突关节的退变,颈椎关节突关节的退变可能是引起青年人颈椎退变的主要原因。现有研究多集中在成人,国内对于学龄前儿童、学龄期儿童也有报道,而对于青少年颈椎小关节形态相关参数鲜有报道。目的:通过三维重建青少年颈椎关节突关节,测量其相关形态参数,并与儿童和成年人进行比较分析,探讨颈椎小关节形态发育的增龄变化规律,为临床颈椎小关节源性颈椎病的诊治和预防提供理论依据。方法:选择13-18岁青少年62例,行颈椎螺旋CT扫描后三维重建,要求无骨质破坏、肿瘤、畸形、骨折等,椎骨形态结构未发生改变,既往无脊柱相关手术,监护人对试验方案知情同意。按年龄分组,A组年龄为13-14岁,B组年龄为15-16岁,C组年龄为17-18岁。对各组青少年进行C_2-C_7关节突关节相关形态测量及统计分析。结果与结论:(1)3组关节突关节面高和关节面宽在随椎序的变化中,分别呈递减和递增趋势,下关节突关节面的高和宽均大于上关节面的相应指标;(2)关节突关节内高在3组年龄中,最小值均位于C5,且与年龄呈正相关变化;(3)关节突关节面间隙在3组中,A组C_(4-5)、B组C_(3-4)和C组C_(4-5)明显大于各组其余间隙;A、B组除C_(4-5)外,其余无显著性差异;C组除C_(2-3)其余椎序间关节面间隙均明显大于A、B组;(4)提示颈椎关节突关节面的形态随椎序的增加,逐渐由圆形过渡到椭圆形;在组间比较中,关节面高较关节面宽受年龄影响明显;各节段下关节面的面积均大于上关节面的面积,仅在C_(4-5)和C_(5-6)形态和面积有显著性差异;加之关节突关节内高最小值均位于C5,关节突关节面间隙明显增宽处也主要位于C_(3-4)和C(_4-5),因此颈椎失稳多发生于中位节段。

刺络药罐结合推拿整脊疗法用于颈椎小关节紊乱患者的临床疗效

目的 分析颈椎小关节紊乱患者采用刺络药罐结合推拿整脊疗法的效果。方法 回顾性选取2021年1月—2023年6月山东颐养健康集团淄博医院骨科收治的52例颈椎小关节紊乱患者的临床资料,根据治疗方案不同分为对照组(采用推拿整脊疗法)和观察组(采用推拿整脊疗法+刺络药罐疗法),各26例。对比两组治疗有效率、疼痛情况、病症分数。结果 观察组治疗总有效率为96.15%(25/26),高于对照组的69.23%(18/26),差异有统计学意义(χ^(2)=4.837,P<0.05)。治疗后,观察组视觉模拟评分法评分低于对照组,差异有统计学意义(P<0.05)。治疗前,两组眩晕、僵硬不适、活动受限、肿胀评分对比,差异无统计学意义(P均>0.05)。治疗后,两组上述评分均降低,且观察组低于对照组,差异有统计学意义(P均<0.05)。结论 颈椎小关节紊乱患者采取刺络药罐结合推拿整脊疗法治疗效果显著,患者活动受限、眩晕、僵硬不适等症状均有所改善,疼痛缓解。

Sensory and sympathetic innervation of cervical facet joint in rats

Objective： To explore the patterns of innervation of cervical facet joints and determine the pathways from facet joints to dorsal root ganglions （DRGs） in order to clarify the causes of diffuse neck pain, headache, and shoulder pain. Methods： Forty-two male Sprague-Dawley rats, weighing 250-300 g, were randomly divided into three groups： Group A （ n = 18） , Group B （ n = 18） , and Group C （ n = 6 ）. Under anesthesia with intraperitoneal pentobarbital sodium （45 mg/kg body weight）, a midline dorsal longitudinal incision was made over the cervical spine to expose the left cervical facet joint capsule of all the rats under a microscope. The rats in Group A underwent sympathectomy, but the rats in Group B and Group C did not undergo sympathectomy. Then 0.6 μl 5 % bisbenzimide （Bb） were injected into the C1-2, C3-4 and C5-6 facet joints of 6 rats respectively in Group A and Group B. The holes were immediately sealed with mineral wax to prevent leakage of Bb and the fascia and skin were closed. But in Group C, 0.9% normal saline was injected into the corresponding joint capsules. Then under deep reanesthesia with intraperitoneal pentobarbital sodium （45 mg/kg body weight）, C1 -C8 left DRGs in all rats and the sympathetic ganglions in Group B were obtained and the number of the labeled neurons was determined. Results ： Neurons labeled with Bb were present in C1- C8 DRGs in both Group A and Group B, and sympathetic ganglions in Group B. In the C1-2 and C3-4 subgroups, labeled neurons were present from C1to C8 DRGs, while in C5-6 subgroups they were from C3 to C8. The number of Bb （＋） neurons after sympathectomy was not significantly different in the injected level from that without sympathectomy. But in the other levels, the number of Bb （ ＋ ） neurons after sympathectomy was significantly less than that without sympathectomy. Conclusions： The innervation of the cervical facet joints is derived from both sensory and sympathetic nervous system, and DRGs are associated with sympathetic ganglions through nerve fibers outside the central nerve system.

体位对颈椎旋转手法整复神经根型颈椎病关节突关节骨错缝的有限元分析

背景:颈椎旋转手法的操作体位主要包括前屈位、中立位、后伸位和旋转方向,关于选用哪种体位实施颈椎旋转手法更有利于整复关节突关节骨错缝治疗神经根型颈椎病,目前尚不清晰。目的:比较不同体位实施颈椎旋转手法整复关节突关节骨错缝治疗神经根型颈椎病的生物力学差异。方法:建立并验证C_(5)-C_(6)正常三维有限元模型,分别模拟前屈、中立、后伸体位往右侧旋转实施颈椎旋转手法,比较不同体位实施颈椎旋转手法时C_(5)双侧下关节突的前后方向和上下方向位移分布。选取整复侧C_(5)下关节突的相同结点作为位移值参考点,比较不同体位实施颈椎旋转手法时整复侧C_(5)下关节突的前后方向和上下方向位移值。结果与结论:①在前屈、中立和后伸3种体位实施颈椎旋转手法,旋转侧C_(5)下关节突均向后下滑动,旋转对侧C_(5)下关节突均向前上滑动,所以C_(5)下关节突的滑动趋势与旋转方向有明显相关性,而与前屈、中立和后伸体位没有明显相关性;②在前屈、中立、后伸体位实施颈椎旋转手法,旋转对侧C_(5)下关节突的向前位移值分别是1.32,1.22和0.77 mm,向上位移值分别是1.49,1.29和0.29 mm;③结果显示,前屈位实施颈椎旋转手法使旋转对侧下关节突的前上位移值最大,说明前屈位往健侧旋转实施颈椎旋转手法可能更有利于整复关节突关节骨错缝治疗神经根型颈椎病。

后路椎间盘镜通道下解除关节突关节交锁联合前路椎管减压融合内固定术在单侧关节突关节交锁难复性下颈椎骨折脱位中的应用研究

目的探讨后路椎间盘镜(MED)通道下解除关节突关节交锁联合前路椎管减压融合内固定术治疗单侧关节突关节交锁难复性下颈椎骨折脱位的可行性及临床疗效。方法选取2016年3月至2019年2月于本院行后路MED通道下解除关节突关节交锁联合前路椎管减压融合内固定术治疗的13例单侧关节突关节交锁难复性下颈椎骨折脱位患者作为研究对象,术前均完善X线、三维CT、MRI等检查,记录患者手术时间、出血量,观察手术前后损伤节段椎体脱位复位、术后神经功能恢复、植骨融合等情况,评估手术疗效。结果13例患者均顺利完成手术,椎体间脱位均完全复位,术中无脊髓神经损伤等并发症发生;手术时间为160~260min,平均(205±45)min;术中出血量为30~310ml,平均(120±75)ml;术后均获随访,随访时间6~28个月,平均(14±6)个月;2例美国脊髓损伤协会(ASIA)A级患者中,1例术后恢复至ASIAB级,1例恢复至ASIAC级,2例ASIAB级患者恢复至ASIAD级,2例ASIAC级患者改善至ASIAD级,3例ASIAD级患者均完全恢复,4例ASIAE级患者无加重;椎体间植骨在8个月内牢固融合(平均6个月),内固定无松动,椎间序列良好。结论后路MED通道下解除关节突关节交锁联合前路椎管减压融合内固定术治疗单侧关节突关节交锁难复性下颈椎骨折脱位疗效显著,可明显减少手术创伤,生物力学稳定,值得临床推广应用。

手足同名经配穴针灸联合Mulligan关节松动术治疗神经根型颈椎病疗效观察

目的观察手足同名经配穴法针灸联合颈椎松解术与常规针灸治疗神经根型颈椎病的临床疗效差异。方法将60例神经根型颈椎病患者采用随机数字表的方法分为观察组和对照组各30例,其中观察组采用手足同名经配穴针灸联合Mulligan关节松动术治疗,对照组常规针灸联合Mulligan关节松动术治疗,两组患者均隔天1次,每周治疗3次,共治疗2周。观察治疗前后、治疗3个月后20分法量表和McGill疼痛量表法[含疼痛视觉模拟评分(VAS)、疼痛分级指数(PRI)、疼痛强度(PPI)评分情况],比较两组的临床疗效。结果治疗后观察组与对照组有效率分别为93.3%(28/30),83.3%(25/30),观察组有效率明显高于对照组,与治疗前相比,两组患者治疗后及随访3个月20分量表评分和PRI、VAS、PPI评分均有改善(P<0.05);与对照组相比,观察组治疗后及随访3个月改善效果均更显著(P<0.05)。结论实施同名经配穴法针灸联合颈椎松解术疗法可更有效的缓解患者局部肌肉症状,尤其是缓解疼痛症状有明显优势,改善患者功能障碍,提高患者生活质量,随访3个月后疗效仍有优势,为在临床治疗提供了更有效的治疗方式。

旋提手法治疗颈椎病研究进展

颈椎病(CS)是脊柱常见、多发疾病之一,具有发病率高,且呈年轻化发展的趋势。CS严重影响患者生活质量和心理健康,旋提手法治疗CS具有安全、有效、经济的特点。通过对筋骨理论以及旋提手法的深入挖掘,探讨在筋骨理论指导下颈椎病的发病机制以及旋提手法治疗CS的作用机制,为手法治疗CS提供新思路。

温灸刮痧技术治疗1例项痹病颈肩疼痛伴颈肩活动受限患者的护理体会

本文总结1例项痹病颈肩疼痛伴颈肩活动受限患者采用温灸刮痧疗法的护理经验。基于中医基础理论和辨证施护,通过开展温灸刮痧,提高患者机体抵抗力,缓解疼痛,改善症状,提高肩关节活动度。

林创坚采用手法结合中药及核心肌群锻炼治疗神经根型颈椎病的经验

林创坚教授结合多年临床经验,认为岭南地区神经根型颈椎病患者的病机特点为风寒湿痹阻夹瘀。依据由表入里、“肌-筋-骨”并治的理念,自创肌松复合调整手法治疗神经根型颈椎病。手法治疗时先行肌松解筋法,再施以调整复位法。手法治疗后采用经验方“颈康方”(主要由葛根、威灵仙、黄芪、秦艽、木瓜、白芍、桂枝、蜈蚣、炒僵蚕、羌活、陈皮等组成)进行临证加减,配合患者自我核心肌群的功能锻炼,以改善患者症状,实现防治结合。

中药熏洗配合功能训练治疗颈型颈椎病疗效观察

目的:观察中药熏洗治疗中配合功能训练对颈型颈椎病患者的治疗效果。方法:将62例颈型颈椎病患者按随机数字表法分为对照组和观察组各31例。对照组接受中频电治疗,并在正常环境中进行功能训练;观察组接受中频电治疗、中药熏洗治疗,并在熏洗治疗中进行功能训练。在两组患者接受治疗前、治疗4周后及3个月随访时,分别用视觉模拟评分法(VAS)、颈椎功能障碍指数(NDI)评分量表及颈椎各方向的关节活动度对其进行评价。结果:治疗前两组患者VAS评分、NDI评分及颈椎各方向的关节活动度比较,差异无统计学意义(P>0.05)。治疗4周后及3个月随访时,两组患者VAS评分、NDI评分及颈椎各方向的关节活动度均较治疗前有明显改善(P<0.05);且观察组的改善程度比对照组显著,差异具有统计学意义(P<0.05)。结论:中药熏洗治疗中配合功能训练治疗颈型颈椎病可有效缓解疼痛,提高颈椎关节活动度。