Objective To evaluate the clinical efficacy of incising spinal pia mater to relieve pressure and unilateral open-door laminoplasty with internal screw fixation for treatment of the dated spinal cord injury. Methods Fr...Objective To evaluate the clinical efficacy of incising spinal pia mater to relieve pressure and unilateral open-door laminoplasty with internal screw fixation for treatment of the dated spinal cord injury. Methods From March, 2009 to July, 2010, 16 cases with chronic cervical cord injury underwent spinal dura mater incision and unilateral open-door laminoplasty with internal screw fixation. Nerve functions of preand postoperation were evaluated by Frankel classification and the Japanese Orthopaedic Association (JOA) scale. The improvement rate of JOA score at the indicated time was recorded. Results Postoperative Frankel classification rating of 16 patients improved obviously. JOA scores at the 1st month, 3rd month, 6th month, and 12th month after surgery were 7.9±2.3, 8.5±1.6, 8.9±2.1, and 12.4±2.5, respectively, and significantly increased compared with that prior to surgery (5.5±0.6). At the end of follow-up period, JOA score was significantly higher than that of pre-treatment (P<0.05). The recovery was relatively rapid during the first 3 months following the surgery, then entered a platform period. Conclusion It is effective for patients with dated spinal cord injury to undergo spinal decompression and laminoplasty.展开更多
BACKGROUND Posterior atlantoaxial dislocation(PAD)is a rare type of upper cervical spine disease.We sought to describe a unreported case of old PAD with os odontoideum(OO)and atlas hypoplasia(AH)and our unique treatme...BACKGROUND Posterior atlantoaxial dislocation(PAD)is a rare type of upper cervical spine disease.We sought to describe a unreported case of old PAD with os odontoideum(OO)and atlas hypoplasia(AH)and our unique treatment approach consisting of C1 single door laminoplasty with C1-3 posterior fixation and fusion.CASE SUMMARY A 70-year-old male patient who suffered from progressive aggravating numbness and limb weakness for 4 years without trauma,was diagnosed with old PAD with OO and AH.The patient underwent closed reduction and C1 single door laminoplasty with C1-3 posterior fixation and fusion instead of C1 laminectomy with occipitocervical fusion.During the 3-year follow-up,he was able to walk by himself instead of using a wheelchair and with a±25°range of head rotation as well as a±10°range of flexion-extension.Three-year follow-up images showed satisfactory reduction and fusion.CONCLUSION C1 single door laminoplasty with cervical fusion in PAD combined with spinal cord compression could be a suitable and effective surgical option.Compared with laminectomy and occipitocervical fusion,it retains more cervical range of motion,has a smaller incision and provides an adequate bone grafting space for atlantoaxial fusion.展开更多
Auricular acupuncture combined with local anaesthesia in cervical larninoplasty was studied. The aim of the study was to observe the analgesic action of this anaesthesia and the effects on respiratory and circulatory ...Auricular acupuncture combined with local anaesthesia in cervical larninoplasty was studied. The aim of the study was to observe the analgesic action of this anaesthesia and the effects on respiratory and circulatory function. 70 patients were included in the study. There were 55 male and 15 female patients, aged between 39 and 67 years old. The unilateral otopoints including Shenmen, cervical vertebrae, sympathetic, subcortex, external lung and kidney points were used. The sterilized filiform needle of 1 - 1. 5 cm were inserted into each otopoint and connected to 57 - 6 electrcrpulse stimulator being stimulated with continuous wave. Local infiltration anaesthesia was also used with 1 - 2 g/L Lignocaine. The results showed that all the patients were conscious, quiet and co-operative with doctors.The respiration, blood pressure and heart rate were all stable. Analgesie action was rather definite. All the patients recovered quickly after operation. We consider that this anaesthesia is a very simple and effective method for cervical laminoplasty.展开更多
BACKGROUND Hydrocephalus following dural tear after spinal surgery is rare.Although a few cases of obstructive hydrocephalus caused by subdural fluid collection and communicating hydrocephalus associated with meningit...BACKGROUND Hydrocephalus following dural tear after spinal surgery is rare.Although a few cases of obstructive hydrocephalus caused by subdural fluid collection and communicating hydrocephalus associated with meningitis have been reported,the mechanism remains uncertain.Herein we describe a patient complicated with hydrocephalus after cervical laminoplasty in whom subdural fluid collection in the cervical spine and posterior cranial fossa rather than chronic meningitis was the main mechanism.CASE SUMMARY A 45-year-old man underwent cervical laminoplasty for cervical spondylotic myelopathy at a local hospital.Ten days postoperatively,a high fever occurred and magnetic resonance imaging(MRI)showed cerebrospinal fluid(CSF)leakage.Pseudomeningocele liquid test showed high levels of protein and white blood cell(WBC)count with negative bacterial culture.The patient was treated with shortterm intravenous antibiotic and discharged with normal body temperature.The patient was uneventful during the first 8 mo follow-up although repeated MRI showed persistent pseudomeningocele.At the 9th mo postoperatively,the patient gradually presented with dizziness and headache accompanied by recurrent weakness of his left arm.Imaging examinations demonstrated hydrocephalus and a cystic lesion around the cervical spinal cord.CSF test from lumbar puncture indicated chronic meningitis.MRI on 1 d after pseudomeningocele drainage showed a significant decrease in the cystic volume,suggesting that the cystic lesion would be subdural fluid collection rather than adhesive arachnoiditis.After dural defect repair,the patient’s symptoms completely resolved and hydrocephalus gradually disappeared.CSF analysis at the 21-mo follow-up revealed significantly decreased protein level and WBC count.CONCLUSION Subdural fluid collection rather than meningitis contributes to the hydrocephalus formation after cervical laminoplasty.展开更多
Cervical laminoplasty surgery is an alternative to laminectomy. It can increase the space of the spinal cord available by raising the lamina, and achieve the indirect decompression effect to treat cervical spondylosis...Cervical laminoplasty surgery is an alternative to laminectomy. It can increase the space of the spinal cord available by raising the lamina, and achieve the indirect decompression effect to treat cervical spondylosis. Various techniques of laminoplasty have since been developed after two prototype techniques: Hirabayashi's open-door laminoplasty and Kurokawa's double-door laminoplasty. Several studies report superior biomechanical stability of the cervical spine after laminoplasty compared with laminectomy. Recent development in laminoplasty is preservation of muscle attachment, which enabled dynamic and static stabilization of the cervical spine by neck extensor muscles. After treatment with new laminoplasty techniques with active postoperative neck muscle exercises, postoperative instability, kyphosis, axial neck pain, and loss of ROM become minimal. The development,complications and future trends of cervical laminoplasty are summarized below.展开更多
目的:探讨中国汉族多节段脊髓型颈椎病(multilevel cervical spondylotic myelopathy,MCSM)患者下颈椎椎板形态学特征,比较其与欧洲高加索人MCSM患者的差异。方法:选取2016年12月~2022年5月在南京大学医学院附属鼓楼医院及法国里昂公园...目的:探讨中国汉族多节段脊髓型颈椎病(multilevel cervical spondylotic myelopathy,MCSM)患者下颈椎椎板形态学特征,比较其与欧洲高加索人MCSM患者的差异。方法:选取2016年12月~2022年5月在南京大学医学院附属鼓楼医院及法国里昂公园医院接受单开门椎管扩大成形术(expansive single open-door laminoplasty,EOLP)治疗的MCSM患者,根据人种分为两组:A组,中国汉族MCSM患者,80例,其中男性42例,女性38例,年龄60.3±10.5岁;B组,欧洲高加索人MCSM患者,29例,其中男性15例,女性14例,年龄58.4±12.6岁。在研究对象术前颈椎CT平扫影像资料上测量颈椎椎板开槽处内径(lamina inner width,LIW)、椎板开槽处外径(lamina outer width,LOW)、椎板轴长(lamina axis length,LAL)、椎板横截面倾斜角(lamina transverse angle,LTA)。应用独立样本t检验比较两组患者C3~C7各节段影像学参数的差异。结果:两组患者LIW及LOW均表现为C3~C5逐渐减小、C5~C7逐渐增大。A组各节段LAL均显著性小于B组(C3:12.1mm vs 13.4mm;C4:12.5mm vs 13.5mm;C5:12.8mm vs 13.9mm;C6:13.1mm vs 14.4mm;C7:13.5mm vs 14.4mm),LIW大于B组(C3:2.8mm vs 2.4mm;C4:2.4mm vs 1.9mm;C5:2.2mm vs 1.7mm;C6:2.7mm vs 2.3mm;C7:4.1mm vs 3.7mm),且在C3~C6节段存在显著性差异(P<0.05);两组LOW及LTA在各节段均无显著性差异(P>0.05)。结论:在中国汉族人群与欧洲高加索人群中,MCSM患者C5节段椎板铰链处最为薄弱,在接受EOLP磨取骨槽时更易断裂,且理论上中国汉族患者铰链处断裂风险大于欧洲高加索人患者。展开更多
目的:应用有限元技术建立颈椎多节段椎管狭窄伴不稳模型,分析并比较后路单开门椎管扩大成形术联合单侧或双侧侧块螺钉固定时的稳定性区别。方法:基于宁波市第六医院2023年1月就诊的1例成年男性志愿者颈椎CT扫描数据,构建C0~T1带肌肉的...目的:应用有限元技术建立颈椎多节段椎管狭窄伴不稳模型,分析并比较后路单开门椎管扩大成形术联合单侧或双侧侧块螺钉固定时的稳定性区别。方法:基于宁波市第六医院2023年1月就诊的1例成年男性志愿者颈椎CT扫描数据,构建C0~T1带肌肉的颈椎有限元模型。该模型在屈伸、侧屈及旋转方向活动度(range of motion,ROM)与以往文献结果相近,应力分布合理,有较高可信度。在完整模型基础上通过有限元技术,分别生成颈椎多节段椎管狭窄及多节段椎管狭窄伴不稳的有限元模型。将上述两个模型左侧作为开门侧,删除全层椎板,并采用钛板固定,右侧为门轴侧做V形槽,分别建立多节段椎管狭窄开门模型(经典开门组)和多节段椎管狭窄伴不稳的开门模型(不稳开门组)。在不稳开门组基础上,于C3~C7节段置入单侧或双侧侧块螺钉,分别生成单侧侧块螺钉固定模型(单侧螺钉组)和双侧侧块螺钉固定模型(双侧螺钉组),计算各组模型在屈伸、侧屈和旋转方向的ROM及应力分布情况。采用独立样本F检验对比各组的ROM,两组间比较采用SNK q检验。结果:单侧螺钉组和双侧螺钉组在C3~C7节段各运动方向ROM均低于不稳开门组(P<0.05),双侧螺钉组在C3~C7节段屈伸和侧屈方向ROM低于单侧螺钉组(P<0.05)。单侧螺钉组中螺钉的应力峰值在左侧屈和左旋转方向较大,分别为402.9MPa和450.2MPa;双侧螺钉组中螺钉在前屈和后伸方向的应力峰值明显高于其余方向,分别为409.8MPa和651.0MPa。结论:与单纯行单开门椎管扩大成形术相比,联合单侧侧块螺钉固定或双侧侧块螺钉固定均显示出良好的力学稳定性。展开更多
文摘Objective To evaluate the clinical efficacy of incising spinal pia mater to relieve pressure and unilateral open-door laminoplasty with internal screw fixation for treatment of the dated spinal cord injury. Methods From March, 2009 to July, 2010, 16 cases with chronic cervical cord injury underwent spinal dura mater incision and unilateral open-door laminoplasty with internal screw fixation. Nerve functions of preand postoperation were evaluated by Frankel classification and the Japanese Orthopaedic Association (JOA) scale. The improvement rate of JOA score at the indicated time was recorded. Results Postoperative Frankel classification rating of 16 patients improved obviously. JOA scores at the 1st month, 3rd month, 6th month, and 12th month after surgery were 7.9±2.3, 8.5±1.6, 8.9±2.1, and 12.4±2.5, respectively, and significantly increased compared with that prior to surgery (5.5±0.6). At the end of follow-up period, JOA score was significantly higher than that of pre-treatment (P<0.05). The recovery was relatively rapid during the first 3 months following the surgery, then entered a platform period. Conclusion It is effective for patients with dated spinal cord injury to undergo spinal decompression and laminoplasty.
文摘BACKGROUND Posterior atlantoaxial dislocation(PAD)is a rare type of upper cervical spine disease.We sought to describe a unreported case of old PAD with os odontoideum(OO)and atlas hypoplasia(AH)and our unique treatment approach consisting of C1 single door laminoplasty with C1-3 posterior fixation and fusion.CASE SUMMARY A 70-year-old male patient who suffered from progressive aggravating numbness and limb weakness for 4 years without trauma,was diagnosed with old PAD with OO and AH.The patient underwent closed reduction and C1 single door laminoplasty with C1-3 posterior fixation and fusion instead of C1 laminectomy with occipitocervical fusion.During the 3-year follow-up,he was able to walk by himself instead of using a wheelchair and with a±25°range of head rotation as well as a±10°range of flexion-extension.Three-year follow-up images showed satisfactory reduction and fusion.CONCLUSION C1 single door laminoplasty with cervical fusion in PAD combined with spinal cord compression could be a suitable and effective surgical option.Compared with laminectomy and occipitocervical fusion,it retains more cervical range of motion,has a smaller incision and provides an adequate bone grafting space for atlantoaxial fusion.
文摘Auricular acupuncture combined with local anaesthesia in cervical larninoplasty was studied. The aim of the study was to observe the analgesic action of this anaesthesia and the effects on respiratory and circulatory function. 70 patients were included in the study. There were 55 male and 15 female patients, aged between 39 and 67 years old. The unilateral otopoints including Shenmen, cervical vertebrae, sympathetic, subcortex, external lung and kidney points were used. The sterilized filiform needle of 1 - 1. 5 cm were inserted into each otopoint and connected to 57 - 6 electrcrpulse stimulator being stimulated with continuous wave. Local infiltration anaesthesia was also used with 1 - 2 g/L Lignocaine. The results showed that all the patients were conscious, quiet and co-operative with doctors.The respiration, blood pressure and heart rate were all stable. Analgesie action was rather definite. All the patients recovered quickly after operation. We consider that this anaesthesia is a very simple and effective method for cervical laminoplasty.
文摘BACKGROUND Hydrocephalus following dural tear after spinal surgery is rare.Although a few cases of obstructive hydrocephalus caused by subdural fluid collection and communicating hydrocephalus associated with meningitis have been reported,the mechanism remains uncertain.Herein we describe a patient complicated with hydrocephalus after cervical laminoplasty in whom subdural fluid collection in the cervical spine and posterior cranial fossa rather than chronic meningitis was the main mechanism.CASE SUMMARY A 45-year-old man underwent cervical laminoplasty for cervical spondylotic myelopathy at a local hospital.Ten days postoperatively,a high fever occurred and magnetic resonance imaging(MRI)showed cerebrospinal fluid(CSF)leakage.Pseudomeningocele liquid test showed high levels of protein and white blood cell(WBC)count with negative bacterial culture.The patient was treated with shortterm intravenous antibiotic and discharged with normal body temperature.The patient was uneventful during the first 8 mo follow-up although repeated MRI showed persistent pseudomeningocele.At the 9th mo postoperatively,the patient gradually presented with dizziness and headache accompanied by recurrent weakness of his left arm.Imaging examinations demonstrated hydrocephalus and a cystic lesion around the cervical spinal cord.CSF test from lumbar puncture indicated chronic meningitis.MRI on 1 d after pseudomeningocele drainage showed a significant decrease in the cystic volume,suggesting that the cystic lesion would be subdural fluid collection rather than adhesive arachnoiditis.After dural defect repair,the patient’s symptoms completely resolved and hydrocephalus gradually disappeared.CSF analysis at the 21-mo follow-up revealed significantly decreased protein level and WBC count.CONCLUSION Subdural fluid collection rather than meningitis contributes to the hydrocephalus formation after cervical laminoplasty.
基金National Natural Science Foundation of China(81572207).
文摘Cervical laminoplasty surgery is an alternative to laminectomy. It can increase the space of the spinal cord available by raising the lamina, and achieve the indirect decompression effect to treat cervical spondylosis. Various techniques of laminoplasty have since been developed after two prototype techniques: Hirabayashi's open-door laminoplasty and Kurokawa's double-door laminoplasty. Several studies report superior biomechanical stability of the cervical spine after laminoplasty compared with laminectomy. Recent development in laminoplasty is preservation of muscle attachment, which enabled dynamic and static stabilization of the cervical spine by neck extensor muscles. After treatment with new laminoplasty techniques with active postoperative neck muscle exercises, postoperative instability, kyphosis, axial neck pain, and loss of ROM become minimal. The development,complications and future trends of cervical laminoplasty are summarized below.
文摘目的:探讨中国汉族多节段脊髓型颈椎病(multilevel cervical spondylotic myelopathy,MCSM)患者下颈椎椎板形态学特征,比较其与欧洲高加索人MCSM患者的差异。方法:选取2016年12月~2022年5月在南京大学医学院附属鼓楼医院及法国里昂公园医院接受单开门椎管扩大成形术(expansive single open-door laminoplasty,EOLP)治疗的MCSM患者,根据人种分为两组:A组,中国汉族MCSM患者,80例,其中男性42例,女性38例,年龄60.3±10.5岁;B组,欧洲高加索人MCSM患者,29例,其中男性15例,女性14例,年龄58.4±12.6岁。在研究对象术前颈椎CT平扫影像资料上测量颈椎椎板开槽处内径(lamina inner width,LIW)、椎板开槽处外径(lamina outer width,LOW)、椎板轴长(lamina axis length,LAL)、椎板横截面倾斜角(lamina transverse angle,LTA)。应用独立样本t检验比较两组患者C3~C7各节段影像学参数的差异。结果:两组患者LIW及LOW均表现为C3~C5逐渐减小、C5~C7逐渐增大。A组各节段LAL均显著性小于B组(C3:12.1mm vs 13.4mm;C4:12.5mm vs 13.5mm;C5:12.8mm vs 13.9mm;C6:13.1mm vs 14.4mm;C7:13.5mm vs 14.4mm),LIW大于B组(C3:2.8mm vs 2.4mm;C4:2.4mm vs 1.9mm;C5:2.2mm vs 1.7mm;C6:2.7mm vs 2.3mm;C7:4.1mm vs 3.7mm),且在C3~C6节段存在显著性差异(P<0.05);两组LOW及LTA在各节段均无显著性差异(P>0.05)。结论:在中国汉族人群与欧洲高加索人群中,MCSM患者C5节段椎板铰链处最为薄弱,在接受EOLP磨取骨槽时更易断裂,且理论上中国汉族患者铰链处断裂风险大于欧洲高加索人患者。
文摘目的:应用有限元技术建立颈椎多节段椎管狭窄伴不稳模型,分析并比较后路单开门椎管扩大成形术联合单侧或双侧侧块螺钉固定时的稳定性区别。方法:基于宁波市第六医院2023年1月就诊的1例成年男性志愿者颈椎CT扫描数据,构建C0~T1带肌肉的颈椎有限元模型。该模型在屈伸、侧屈及旋转方向活动度(range of motion,ROM)与以往文献结果相近,应力分布合理,有较高可信度。在完整模型基础上通过有限元技术,分别生成颈椎多节段椎管狭窄及多节段椎管狭窄伴不稳的有限元模型。将上述两个模型左侧作为开门侧,删除全层椎板,并采用钛板固定,右侧为门轴侧做V形槽,分别建立多节段椎管狭窄开门模型(经典开门组)和多节段椎管狭窄伴不稳的开门模型(不稳开门组)。在不稳开门组基础上,于C3~C7节段置入单侧或双侧侧块螺钉,分别生成单侧侧块螺钉固定模型(单侧螺钉组)和双侧侧块螺钉固定模型(双侧螺钉组),计算各组模型在屈伸、侧屈和旋转方向的ROM及应力分布情况。采用独立样本F检验对比各组的ROM,两组间比较采用SNK q检验。结果:单侧螺钉组和双侧螺钉组在C3~C7节段各运动方向ROM均低于不稳开门组(P<0.05),双侧螺钉组在C3~C7节段屈伸和侧屈方向ROM低于单侧螺钉组(P<0.05)。单侧螺钉组中螺钉的应力峰值在左侧屈和左旋转方向较大,分别为402.9MPa和450.2MPa;双侧螺钉组中螺钉在前屈和后伸方向的应力峰值明显高于其余方向,分别为409.8MPa和651.0MPa。结论:与单纯行单开门椎管扩大成形术相比,联合单侧侧块螺钉固定或双侧侧块螺钉固定均显示出良好的力学稳定性。
