腰椎管狭窄症脊椎融合术适应症研究进展

腰椎管狭窄症主要由腰椎关节强硬引起。腰椎狭窄症的临床表现分为两类:一类为局域性症状,如下腰痛,僵硬等,一类为神经根症状,如神经性跛行。适当保护性治疗可以改善这些症状,但是一些顽固病例仍需手术治疗。单纯腰椎管减压术适用于以神经根症状为初发表现并且脊椎生物力学稳定的患者。术前评估时如出现背部手术失败综合征,退行性不稳定,严重畸形,有症状的椎骨脱离,难治性退行性椎间盘疾病,以及邻近节段病的患者可行腰椎融合术。术中评估出现广泛椎体压缩合并椎间隙大或者骨储存量不足的患者可行腰椎融合术。     

Evolution of axial patterning in elongate fishes

Within the ray-finned fishes, eel-like (extremely elongate) body forms have evolved multiple times from deeper-bodied forms. Previous studies have shown that elongation of the vertebral column may be associated with an increase in the number of vertebrae, an increase in the length of the vertebral centra, or a combination of both. Because the vertebral column of fishes has at least two anatomically distinct regions (i.e. abdominal and caudal), an increase in the number and relative length of the vertebrae could be region-specific or occur globally across the length of the vertebral column. In the present study, we recorded vertebral counts and measurements of vertebral aspect ratio (vertebral length/width) from museum specimens for 54 species representing seven groups of actinopterygian fishes. We also collected, from published literature, vertebral counts for 813 species from 14 orders of actinopterygian and elasmobranch fishes. We found that the number of vertebrae can increase independently in the abdominal and caudal regions of the vertebral column, but changes in aspect ratio occur similarly in both regions. These findings suggest that abdominal vertebral number, caudal vertebral number, and vertebral aspect ratio are controlled by separate developmental modules. Based on these findings, we suggest some candidate developmental mechanisms that may contribute to vertebral column patterning in fishes. Our study is an example of how comparative anatomical studies of adults can generate testable hypotheses of evolutionary changes in developmental mechanisms.  © 2007 The Linnean Society of London, Biological Journal of the Linnean Society , 2007, 90 , 97–116.     

Congenital absence of a tail in a Reeves‘ muntjac (Muntiacus reevesi)

Two abnormalities of the tail have been observed in Reeves muntjac. A male was born acaudate and an adult doe had a tail less than a third of the normal length. The range and mean of lengths of body and tail are given for animals over 2 years old.     

On the cervical vertebrae of the Pterodactyloidea (Reptilia: Archosauria)

Within the Pterodactyloidea, the cervical vertebrae show considerable variation. These elements are also sufficiently common and contain enough anatomical information to make them taxonomically valuable. A survey of these vertebrae concludes that most known pterodactyloids fall into two groups: long-necked forms with attenuated cervical vertebrae that possess low neural spines, and tall-spined forms that possess relatively short neck vertebrae with tall neural spines. These two groups may represent natural taxonomic units. However, this is by no means conclusive and can only be tested by the study of other regions of pterodactyloid skeletons.     

The number of vertebrae in the Southern African Negro,the American Negro and the Bushman (San)

The numbers of precoccygeal vertebrae (PCV) are compared in Southern African Negroes, Bushman (San) and American Negroes. The S.A. Negro and San males have an exceptionally high frequency of an increased total PCV number whilst the frequencies are significantly lower in a combined Caucasoid sample and the Mongoloid samples. The American Negro male, too, has a high frequency but not as high as in S.A. Negroes. The high frequency of increased PCV number in San, S.A. Negroes and American Negroes is in keeping with the view that the Khoisan peoples (here represented by the San), the Southern African Negroes and the African ancestors of American Blacks sprang from a common proto-negriform stock. Males have a significantly greater frequency of increased PCV to 30 or 31, whereas females are more likely to have a decreased number of 28 PCV. This sex difference is present in all the populations studied.     

“Lucy” (A.L. 288‐1) had five sacral vertebrae

A “long‐backed” scenario of hominin vertebral evolution posits that early hominins possessed six lumbar vertebrae coupled with a high frequency of four sacral vertebrae (7:12‐13:6:4), a configuration acquired from a hominin‐panin last common ancestor (PLCA) having a vertebral formula of 7:13:6‐7:4. One founding line of evidence for this hypothesis is the recent assertion that the “Lucy” sacrum (A.L. 288‐1an, Australopithecus afarensis) consists of four sacral vertebrae and a partially‐fused first coccygeal vertebra (Co1), rather than five sacral vertebrae as in modern humans. This study reassesses the number of sacral vertebrae in Lucy by reexamining the distal end of A.L.288‐1an in the context of a comparative sample of modern human sacra and Co1 vertebrae, and the sacrum of A. sediba (MH2). Results demonstrate that, similar to S5 in modern humans and A. sediba, the last vertebra in A.L. 288‐1an exhibits inferiorly‐projecting (right side) cornua and a kidney‐shaped inferior body articular surface. This morphology is inconsistent with that of fused or isolated Co1 vertebrae in humans, which either lack cornua or possess only superiorly‐projecting cornua, and have more circularly‐shaped inferior body articular surfaces. The level at which the hiatus' apex is located is also more compatible with typical five‐element modern human sacra and A. sediba than if only four sacral vertebrae are present. Our observations suggest that A.L. 288‐1 possessed five sacral vertebrae as in modern humans; thus, sacral number in “Lucy” does not indicate a directional change in vertebral count that can provide information on the PLCA ancestral condition. Am J Phys Anthropol 156:295–303, 2015. © 2014 Wiley Periodicals, Inc.     

Vertebral and rib anatomy in Caperea marginata: Implications for evolutionary patterning of the mammalian vertebral column

The pygmy right whale, Caperea marginata, is a rare mysticete cetacean with an unusual suite of axial skeletal characters. Distally expanded first ribs, a long thorax with broadly overlapping vertebral transverse processes, plate‐like posterior ribs, and a short tail contrast with other cetaceans and suggest unique developmental patterning. Twenty‐four individuals of diverse ontogenetic age were available for analysis. Multiple, variable examples of incomplete rib fusion in dependent calves indicate that the first rib of adults is an ontogenetic fusion product of ribs 1 and 2. The composite rib articulates by way of its anterior (Rib1) component to the sternum and by way of its posterior (Rib2) component with thoracic vertebra 2. Thoracic vertebra 1 lacks rib articulations. When rib fusion is taken into account, the most frequent column formulas are C7T18L1Cd16–17 = 42–43 and C7T17L1Cd16–18 = 41–43. Thoracic and lumbar series are not reciprocal in count, arguing against their developmental linkage. Instead, parallel reduction in both lumbar and caudal counts supports the existence of neocete patterning in Caperea, as in all other living cetaceans. Ontogenetic vertebral column elongation is most marked in the posterior thorax, lumbos, and anterior tail. Vertebrae in these column regions are excellent predictors of total body length.