小儿下颈椎稳定性的外科重建

目的 探讨因创伤、结核或肿瘤引起的下颈椎不稳定的重建方法。方法 针对 8例年龄 2～ 7岁 ,平均4 .1岁的患儿行前路减压 ,大块髂骨植骨 ;后路棘突钢丝内固定 ,植骨融合术。结果 术后随访 6个月～ 4年 3个月 ,脊髓神经功能完全恢复 3例 ,部分恢复 4例 ,1例死于并发肺部感染。植骨完全融合 5例 ,处于融合阶段 2例。结论 采用前路减压加大块髂骨植骨 ,后路棘突钢丝内固定融合术 。

Dynamic Radiographic Analysis of Sympathetic Cervical Spondylosis Instability

Objective To investigate the correlation between subaxial cervical spine instability and cervical spondylotic sympathetic symptoms as well as the difference of cervical spondylotic subaxial instability between male and female patients. Methods We analyzed retrospectively 318 surgical cases of cervical spondylosis treated at Department of Orthopedic Surgery of Peking Union Medical College Hospital between July 2003 and December 2007. All cases were divided into group A without sympathetic symptoms (n=284) and group B with sympathetic symptoms (n=34). Angular and horizontal translation values between two adjacent vertebral bodies from C2 to C7 were measured separately on hyperflexion and hyperextension lateral cervical spine radiographs. Fisher's exact test was used to evaluate the correlation between subaxial cervical instability and sympathetic symptoms. Intragroup correlation between patient gender and subaxial cervical instability was also evaluated. Results Subaxial instability incidences in groups A and B were 21.8% (62/284) and 55.9% (19/34), respectively. Statistical analysis indicated a definite correlation between subaxial cervical instability and sympathetic symptoms (P=0.000). Among patients without sympathetic symptoms, subaxial instability incidences were 21.4% (37/173) in males and 22.5% (25/111) in females, respectively (P=0.883). While among patients with sympathetic symptoms, subaxial instability incidences were 27.3% (3/11) in males and 69.6% (16/23) in females, respectively, indicating significant difference (P=0.030). Subaxial instability was most commonly seen at C4-C5 intervertebral space in sympathetic cervical spondylosis patients. Conclusions High correlation exists between subaxial cervical spine instability and cervical spondylotic sympathetic symptoms, especially in female patients. Hyperextension and hyperflexion radiographs of cervical spine are important to assess sympathetic cervical spondylotic subaxial instability.

AXIS颈椎侧块钢板治疗下颈椎不稳临床应用初步报告

目的观察AXIS颈椎侧块钢板治疗下颈椎不稳的近期疗效。方法于正常成人颈椎标本上观察侧块的解剖特点，测量侧块进针点、进针角度和深度。临床应用 AXIS颈椎侧块钢板治疗下颈椎不稳 22例。结果进针点宜选在术中可视侧块中点内下 1～ 2 mm处；进针角度分别为 :矢状面 36°～ 54° (平均 45° )；水平面 23°～ 35° (平均 29° )；进针深度为 10.8～ 17.5 mm(平均 14.5 mm)。无术中血管、神经损伤。 22例平均随访 10个月，未见钢板螺钉松脱、断裂等并发症。 19例获骨性融合，脊髓功能除 2例按 ASIA分级为 A级者术后无改善外，余均有不同程度恢复。结论 AXIS颈椎侧块钢板适合各种原因引起的需后路减压的下颈椎不稳患者的治疗。侧块固定有一定风险，但只要熟悉其解剖特点，正确选择进针点、角度和深度，规范操作，此技术是安全的，可获得良好的临床效果。