Hounsfield units in assessing bone mineral density in ankylosing spondylitis patients with cervical fracture-dislocation

BACKGROUND Cervical spine fracture-dislocations in patients with ankylosing spondylitis(AS)are mostly unstable and require surgery.However,osteoporosis,one of the comorbidities for AS,could lead to detrimental prognoses.There are few accurate assessments of bone mineral density in AS patients.AIM To analyze Hounsfield units(HUs)for assessing bone mineral density in AS patients with cervical fracture-dislocation.METHODS The HUs from C2 to C7 of 51 patients obtained from computed tomography(CT)scans and three-dimensional reconstruction of the cervical spine were independently assessed by two trained spinal surgeons and statistically analyzed.Inter-reader reliability and agreement were assessed by interclass correlation coefficient.RESULTS The HUs decreased gradually from C2 to C7.The mean values of the left and right levels were significantly higher than those in the middle.Among the 51 patients,25 patients(49.02%)may be diagnosed with osteoporosis,and 16 patients(31.37%)may be diagnosed with osteopenia.CONCLUSION The HUs obtained by cervical spine CT are feasible for assessing bone mineral density with excellent agreement in AS patients with cervical fracture-dislocation.

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.

Noncarious Cervical Lesions: Correlation between Abfraction and Wear Facets in Permanent Dentition

Non-carious cervical lesions (NCCLs) are defined as the loss of dental hard tissue at the cement-enamel junction. Erosion, abrasion, and attrition have been associated with this disorder. Objective: Recently, occlusal stress causing of cervical enamel cracks (abfraction) has been considered as an additional etiology for NCCLs to facilitate the erosion and abrasion mechanisms in tooth wear. Study Design: The prevalence of NNCLs and wear facets in a population with permanent dentition in absence of any clear etiological factors related to erosion and abrasion causes is evaluated. A total 295 subjects are enrolled for this study and divided into four age groups (subjects aged 15 - 27 years, 28 - 42 years, 43 - 57 years and 58 - 75 years respectively). An overall of 6629 teeth are investigated to find NCCLs and wear facets. The occlusion is analyzed in each patient. Results: An overall of 801 teeth (12%) show NCCLs and 623 of them (78%) highlight also wear facets. The higher number of teeth with NCCLs and of these with simultaneous presence also of wear facets are found on teeth of patients of group-3 (11% of all teeth examined for group and 81% respectively) and to group-4 (24.4% of all teeth examined for group and 86.5% respectively) of remaining teeth without NCCLs (5828) only 138 (2.4%) shown wear facets. Conclusion: The results of this study held the occlusal forces as the main cause of NCCLs on teeth in presence of wear facets.

Lumbar Facet Cyst Causing S1 Radiculopathy with Concomittent Acute on Chronic Cervical Prolapse Intervertebral Disc, a Rare Case Report

Tandem spinal stenosis is described as concurrent symptomatic cervical and lumbar spinal stenosis. The clinical presentation includes neurogenic claudication, gait disturbance, myelopathy and polyradicuopathy in both upper and lower limbs. A 43-year-old female presented with predominant low back pain with right S1 radiculopathy leading to diagnosis of synovial facet cyst of lumbar spine. She was managed surgically after medical treatment failed. After 1 week post operatively, she presented with severe neck pain with left radiculopathy. MRI revealed acute on chronic cervical prolapsed intervertebral disc, cervical decompression surgery proceeded. Post operative improvement was noted on follow up. We report a case of tandem spinal stenosis, which both of the pathologies were managed with endoscopic approach.

Surgical Treatment of Lower Cervical Locked Facet. An Experience in 20 Cases

Background: Cervical spine injuries are common as a result of a growing number of high energy accidents. The subaxial Injury Classification System and Severity Score (SLICS) suggest that a unilateral or bilateral facet dislocation must be managed surgically, even in the absence of SCI (Level of Evidence III). The surgical approaches could be anterior, posterior or combined anterior and posterior approaches. Methods: 20 patients, 12 males and 8 females, with age ranged from 20 to 45 years with lower cervical spine locked facet treated operatively by anterior or posterior spinal instrumentation after trial of closed reduction by skull traction. Results: In this series, satisfactory closed reduction was achieved in 15 patients with percentage 75% and fixed anteriorly, but 5 patients with percentage 25% needed posterior approach for reduction. Regarding ASIA score all of the patients improved at least one level after surgery except 2 cases with preoperative score A: they didn’t improve. Mean preoperative pain score VAS was 7.7 (range from 5 to 9) and postoperative mean of VAS was 0.75 with range from 0 to 3 until final follow up. Conclusion: Anterior approach with discectomy and fusion is necessary;however, if the closed reduction failed, posterior open reduction is indicated with lateral mass fixation, combined approaches can be indicated in specific cases such as increase of the kyphotic angle post anterior approach or when an osteotomy may be required to restore cervical alignment and neural decompression.

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.

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

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.

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。

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。

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。

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。

单纯前路撬拨复位内固定治疗颈椎骨折脱位伴关节突交锁患者的临床效果

目的 探讨单纯前路撬拨复位内固定治疗颈椎骨折脱位伴关节突交锁患者的临床效果。方法 将60例颈椎骨折脱位伴关节突交锁患者随机分为两组各30例。对照组采用单纯后路钉棒复位内固定治疗,观察组采用单纯前路撬拨复位内固定治疗,比较两组的治疗效果。结果 观察组椎体复位率为96.67%,高于对照组的80.00%(P <0.05)。观察组术后脊髓功能损伤ASIA分级A级、 B级占比低于对照组,E级占比高于对照组(P <0.05)。观察组术后并发症发生率为6.67%,低于对照组的26.67%(P <0.05)。结论 单纯前路撬拨复位内固定治疗可明显提高颈椎骨折脱位伴关节突交锁患者的椎体复位率,减轻患者脊髓功能损伤,降低术后并发症发生率。

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。

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。

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.

下颈椎关节突关节的解剖学测量与经关节螺钉固定的关系

目的:测量下颈椎关节突关节的相关数据,探讨其与经关节螺钉固定的关系。方法:41具成人颈椎干燥标本,测量其颈椎关节突关节的上、下关节面的高度、宽度和冠状面角度以及下关节面在侧块后方投影的高度,并对侧块进行形态学评定;根据Dalcanto技术对30具颈椎标本行经关节突关节螺钉固定,以侧块中心点下2mm为进钉点,在矢状面上尾倾40°、在冠状面上外倾20°置入螺钉,测量螺钉的长度,观察螺钉位置。结果:C3～C7下关节面在侧块后方投影的高度为7.4～9.0mm,侧块的中心点约在下关节面后方投影的上界下方2mm。C6和C7上、下关节面的倾斜角度相对更大,侧块厚度相对较薄。采用Dalcanto技术经关节突关节螺钉固定,螺钉长度从C3/4向C7/T1呈下降趋势,由16.9mm降至15.7mm,其中在C7/T1水平螺钉最短。螺钉由头侧向尾侧经关节突关节复合体,大体上从关节面的中心点穿过;在矢状面上几乎与关节面垂直;无一例损伤到横突孔,螺钉从下位椎体的上关节突基底部的侧前方穿出,钉道指向侧前下方。结论:下颈椎关节突关节复合体可为经此关节螺钉固定提供足够的皮质骨。Dalcanto技术经关节突关节螺钉不仅具有可行性,而且可以避开横突孔,钉道方向几乎与横突沟平行,安全空间较大。由于C6、C7侧块的厚度较薄,在C6/7和C7/T1行经关节固定时不宜使用16mm以上长度的螺钉。

X线引导下颈脊神经后支松解治疗颈脊神经后支源性慢性颈肩痛的临床研究

目的观察在X线引导下行颈4、5脊神经后支松解治疗颈脊神经后支源性慢性颈肩痛的有效性及安全性。方法选取2020年12月至2021年4月武汉市第一医院疼痛科收治的颈脊神经后支源性慢性颈肩痛患者81例。所纳入研究的患者被随机分为两组,松解组(n=40)和阻滞组(n=41)。松解组在X线透视下采用一次性硬膜外穿刺针钝性分离颈4、5脊神经后支,并注射镇痛混合液(倍他米松4 mg+利多卡因40 mg,以盐水稀释至6~12 mL,各点约3 mL)。阻滞组单纯采用颈4、5脊神经后支注射镇痛混合液治疗方法(药物同松解组)。采用视觉模拟评分法(visual analogue scale, VAS)评估患者术前、术后1周、1月及6月疼痛程度;评估术后6月疗效。结果与术前相比,治疗后1周两组的疼痛评分均显著降低,差异有统计学意义(均P<0.05);治疗后1周,松解组与阻滞组患者疼痛评分差异无统计学意义(P>0.05);治疗后1月及6月,松解组患者的VAS评分明显低于阻滞组,差异有统计学意义(均P<0.05)。术后6月疗效评估,松解组(显著有效率93%)要明显优于阻滞组(显著有效率61%),差异有统计学意义(P<0.05)。两组患者术后即时及术后3 d均未出现局部血肿、感染、区域麻木等并发症。结论 X线引导下颈4、5脊神经后支松解术可长期有效改善患者颈肩部疼痛,具有安全、远期效果理想等特点,是颈脊神经后支源性慢性颈肩痛有效的治疗手段。

下颈椎骨折脱位伴关节突交锁的治疗策略选择

[目的]探讨并评估在下颈椎骨折脱位伴关节突交锁时安全、简便和有效的治疗策略。[方法]对16例创伤性下颈椎骨折脱位伴关节突交锁的患者于清醒状态及X线透视机监视下先行早期持续闭合颅骨牵引复位。所有患者在治疗前均行X线片和MRI／CT检查及ASIA神经功能评级。持续闭合牵引复位时行动态ASIA神经功能评级及X线透视机监视。损伤至开始牵引复位的间隔平均为31h（6～52h）。复位成功后维持颅骨牵引并择期行颈前路或颈前后路联合手术。9例患者于复位成功后再次行MRI扫描。[结果]治疗前MRI显示分别有8例和5例患者存在脱位节段的椎间盘突出和损坏；ASIA神经功能评级分别为：C级7例，D级5例，E级4例。16例患者均闭合复位成功且无一例出现神经功能恶化。复位成功后再次MRI扫描显示：6例脱位节段的椎间盘突出中有2例接近自动回纳，4例仍维持原样；3例脱位节段的椎间盘损坏中有2例维持原样，另l例转变为椎间盘突出。平均牵引重量为19kg（10～32kg），平均牵引时间为53min（30～135min）。[结论]当患者处于清醒及检体合作的状态下通过动态神经功能评级及X线透视机监视，对下颈椎骨折脱位伴关节突交锁行早期持续闭合颅骨牵引复位，择期根据全身及局部状况行颈前路或颈前后路联合手术是一种安全、简便和有效的治疗策略。