Bryan颈椎间盘假体置换术对脊髓型颈椎病患者疗效及颈椎生物力学的影响

目的:探讨Bryan颈椎间盘假体置换术对脊髓型颈椎病患者疗效及颈椎生物力学的影响。方法:选取2015年1月到2016年12月期间在我院接受治疗的脊髓型颈椎病患者48例,根据手术方式的不同将其分为植骨融合组(25例)和假体置换组(23例),其中植骨融合组采用颈椎前路减压植骨融合术进行治疗,假体置换组采用Bryan颈椎间盘假体置换术进行治疗。比较两组患者的日本骨科协会(JOA)颈椎评分、颈椎功能障碍指数(NDI)评分、视觉模拟疼痛量表(VAS)评分、颈椎生理曲度、颈椎活动度、手术节段活动度、上邻近节段活动度、下邻近节段活动度,并比较两组患者的并发症情况。结果:术后12个月假体置换组的NDI评分明显低于植骨融合组(P0.05);术后6个月、术后12个月植骨融合组的颈椎活动度低于假体置换组(P0.05);术后1个月、术后3个月、术后6个月、术后12个月假体置换组的手术节段活动度高于植骨融合组(P0.05);术后12个月植骨融合组的上邻近节段活动度、下邻近节段活动度高于假体置换组(P0.05);两组患者随访期间颈部轴性症状发生率比较差异有统计学意义(P0.05)。结论:与颈椎前路减压植骨融合术比较,Bryan颈椎间盘假体置换术对脊髓型颈椎病患者的远期疗效更佳,可更好的改善患者的颈椎生物力学,降低颈部轴性症状发生率,值得临床推广应用。     

内镜下治疗跟骨骨刺合并跖腱膜炎所致跟骨痛的临床应用

目的:介绍和分析内镜下治疗跟骨骨刺合并跖腱膜炎所致跟骨痛应用。方法:对2011.10-2014.10来我院就诊的共计67例跟骨骨刺合并跖腱膜炎所致跟骨痛的资料进行分析包括患者术前与术后3月、6月及12月VAS(Visual Analogue Scale)疼痛评分,X线或MRI等影像学资料及和AOFAS(the American Orthopedic Foot and Ankle Society)足踝标准及并发症等指标。结果:患者均接受了至少12个月随访,患者在术后(3,6,12月)的VAS评分及AOFAS评分较术前均有显著改善和提高(P0.05)。影像资料显示:骨刺未见明显复发。1例患者出现皮肤浅层感染,处理后好转,余无明显并发症出现。结论:内镜下治疗跟骨骨刺合并跖腱膜炎对于跟骨痛有较好的疗效。     

Mechanical implications of pneumatic neck vertebrae in sauropod dinosaurs

The pre-sacral vertebrae of most sauropod dinosaurs were surrounded by interconnected, air-filled diverticula, penetrating into the bones and creating an intricate internal cavity system within the vertebrae. Computational finite-element models of two sauropod cervical vertebrae now demonstrate the mechanical reason for vertebral pneumaticity. The analyses show that the structure of the cervical vertebrae leads to an even distribution of all occurring stress fields along the vertebrae, concentrated mainly on their external surface and the vertebral laminae. The regions between vertebral laminae and the interior part of the vertebral body including thin bony struts and septa are mostly unloaded and pneumatic structures are positioned in these regions of minimal stress. The morphology of sauropod cervical vertebrae was influenced by strongly segmented axial neck muscles, which require only small attachment areas on each vertebra, and pneumatic epithelia that are able to resorb bone that is not mechanically loaded. The interaction of these soft tissues with the bony tissue of the vertebrae produced lightweight, air-filled vertebrae in which most stresses were borne by the external cortical bone. Cervical pneumaticity was therefore an important prerequisite for neck enlargement in sauropods. Thus, we expect that vertebral pneumaticity in other parts of the body to have a similar role in enabling gigantism.     

应用反向滤过及迭代重建方法评估标准放射剂量与低剂量颈椎 CT图像质量的对比研究

目的：利用反向滤过重建（filtered back-projection,FBP）及迭代重建（iterative reconstruction,IR）方法评估标准剂量及低剂量 对颈椎CT 图像质量的影响。方法：40 例受检对象行颈椎CT 检查,将其随机分为两组：标准剂量组（SD,120 kVp, 275 mAs）及低 剂量组（LD,120 kVp,150 mAs）,随机选择管电流值,所有数据均行FBP 及IR 重建。测量C3 C4 及C6 C7 椎间盘水平椎间盘、脊 神经、脊髓、韧带以及周围软组织的图像噪声值（Image noise,IN）,信噪比（signal-to-noise,SNR）及对比信噪比（contrast-to-noise, CNR）。结果：在测量的各椎间盘水平,迭代重建的信噪比及对比噪声比要明显高于反向滤过重建方法,并有效的降低了图像噪 声。低剂量迭代重建图像与标准剂量反向滤过图像相比无明显统计学意义。排除剂量及扫描层面的影响,椎间盘、脊神经及韧带 的图像质量,迭代重建评分要明显高于反向滤过重建,结果具有统计学差异;而低剂量迭代重建图像质量评分与标准剂量反向滤 过重建相比无明显差异。软组织及椎体的图像质量,迭代重建图像质量评分要低于反向滤过重建方法,结果具有统计学差异;而 低剂量迭代重建图像质量评分与标准剂量反向滤过重建相比无明显差异。整体病例图像质量评分,迭代重建方法要高于反向滤 过重建方法,低剂量迭代重建方法要高于标准剂量反向滤过重建方法。结论：应用低剂量扫描方式以及迭代重建方法进行颈椎 CT 检查可以为临床提供较好的图像质量,对于椎间盘、脊神经、脊髓显示较好,对于周围软组织以及椎体来说,图像质量相对较 差,同时可以降低大约40%的放射剂量。     

应用反向滤过及迭代重建方法评估标准放射剂量与低剂量颈椎CT图像质量的对比研究

目的：利用反向滤过重建（filtered back-projecfion,FBP）及迭代重建（iterative reconstruction,IR）方法评估标准剂量及低剂量对颈椎CT图像质量的影响。方法：40例受检对象行颈椎CT检查,将其随机分为两组：标准剂量组（SD,120kVp,275mAs）及低剂量组（LD,120kVp,150mAs）,随机选择管电流值,所有数据均行FBP及IR重建。测量C3C4及C6C7椎间盘水平椎间盘、脊神经、脊髓、韧带以及周围软组织的图像噪声值（Imagenoise,IN）,信噪比（signal—to—noise,SNR）及对比信噪比（contrast—to—noise,CNR）。结果：在测量的各椎间盘水平,迭代重建的信噪比及对比噪声比要明显高于反向滤过重建方法,并有效的降低了图像噪声。低剂量迭代重建图像与标准剂量反向滤过图像相比无明显统计学意义。排除剂量及扫描层面的影响,椎间盘、脊神经及韧带的图像质量,迭代重建评分要明显高于反向滤过重建,结果具有统计学差异;而低剂量迭代重建图像质量评分与标准剂量反向滤过重建相比无明显差异。软组织及椎体的图像质量,迭代重建图像质量评分要低于反向滤过重建方法,结果具有统计学差异;而低剂量迭代重建图像质量评分与标准剂量反向滤过重建相比无明显差异。整体病例图像质量评分,迭代重建方法要高于反向滤过重建方法,低剂量迭代重建方法要高于标准剂量反向滤过重建方法。结论：应用低剂量扫描方式以及迭代重建方法进行颈椎CT检查可以为I临床提供较好的图像质量,对于椎间盘、脊神经、脊髓显示较好,对于周围软组织以及椎体来说,图像质量相对较差,同时可以降低大约40％的放射剂量。     

Effect of mechanical loading on heterotopic ossification in cervical total disc replacement: a three-dimensional finite element analysis

The development of heterotopic ossification (HO) is considered one of the major complications following cervical total disc replacement (TDR). Even though previous studies have identified clinical and biomechanical conditions that may stimulate HO, the mechanism of HO formation has not been fully elucidated. The objective of this study is to investigate whether mechanical loading is a biomechanical condition that plays a substantial role to decide the HO formation. A finite element model of TDR on the C5–C6 was developed, and HO formation was predicted by simulating a bone adaptation process under various physiological mechanical loadings. The distributions of strain energy on vertebrae were assessed after HO formation. For the compressive force, most of the HO formation occurred on the vertebral endplates uncovered by the implant footplate which was similar to the Type 1 HO. For the anteriorly directed shear force, the HO was predominantly formed in the anterior parts of both the upper and lower vertebrae as the Type 2 HO. For both the flexion and extension moments, the HO shapes were similar to those for the shear force. The total strain energy was reduced after HO formation for all loading conditions. Two distinct types of HO were predicted based on mechanically induced bone adaptation processes, and our findings were consistent with those of previous clinical studies. HO formation might have a role in compensating for the non-uniform strain energy distribution which is one of the mechanical parameters related to the bone remodeling after cervical TDR.     

Comparison of Modic Changes in the Lumbar and Cervical Spine,in 3167 Patients with and without Spinal Pain

Background Context

There are few comparisons of Modic changes (MCs) in the lumbar and cervical spine.

Purpose

Compare the prevalence of MCs in the lumbar and cervical spine, and determine how MC prevalence depends on spinal pain, age, disc degeneration, spinal level, and the presence or absence of kyphosis.

Study Design

Retrospective clinical survey.

Materials and Methods

Magnetic resonance images (MRIs) were compared from five patient groups: 1. 1223 patients with low-back pain/radiculopathy only; 2. 1023 patients with neck pain/radiculopathy only; 3. 497 patients with concurrent low-back and neck symptoms; 4. 304 asymptomatic subjects with lumbar MRIs; and 5. 120 asymptomatic subjects with cervical MRIs.

Results

The prevalence of MCs was higher in those with spinal pain than in those without, both in the lumbar spine (21.0% vs 10.5%) and cervical spine (8.8% vs 3.3%). Type II MCs were most common and Type III were least common in all groups. The prevalence of lumbar MCs in people with back pain was little affected by the presence of concurrent neck pain, and the same was true for the prevalence of cervical MCs in people with neck pain with or without concurrent back pain. When symptomatic patients were reclassified into two groups (back pain, neck pain), the prevalence of lumbar MCs in people with back pain was greater than that of cervical MCs in people with neck pain. The prevalence of lumbar and cervical MCs increased with age, disc degeneration, (descending) spinal level, and increased kyphosis.

Conclusions

There is a significantly higher prevalence of MCs in patients with back and neck pain. The reported association with increased kyphosis (flat back) is novel.     

单节段颈椎人工椎间盘置换术治疗颈椎病的临床研究

目的:探讨单节段颈椎人工椎间盘置换术(CDA)治疗颈椎病的临床效果。方法:选择2013年5月到2015年5月在我院收治的80例颈椎病患者,按手术方式不同分为颈椎人工椎间盘置换组(CDA组)和前路颈椎减压融合组(ACDF组),各40例。两组患者均于术前、术后3个月、术后6个月及术后1年进行末期随访时,采用颈椎功能障碍指数(NDI)评价患者颈部功能,采用颈痛视觉模拟评分(VAS)和上肢痛VAS评价患者颈部疼痛,采用X线片在过伸和过屈位测量患者术前和术后手术节段相邻节段的活动度。结果:两组患者术后3个月、6个月及术后1年时的NDI评分、颈痛VAS及上肢痛VAS均明显低于术前,差异具有统计学意义(P0.05),然而两组间比较差异无统计学意义(P0.05)。CDA组患者术后3个月、6个月及术后1年时的手术相邻上节段活动度和手术相邻下节段活动度与术前比较差异无统计学意义(P0.05),而ACDF组患者术后3个月、6个月及术后1年时均明显高于术前及同期CDA组,差异具有统计学意义(P0.05)。结论:单节段CDA治疗颈椎病的临床疗效与ACDF相近,另外其不会引起手术相邻节段活动度的增加,值得在临床上推广应用。     

Morphometric analysis of vertebrae and intervertebral discs as a basis of disc replacement

In this study measurements were obtained from 359 vertebrae and 215 intervertebral discs in an attempt to classify discs by their size. At the cervical and thoracic levels, this attempt was unproductive because of extensive variations. In the lumbar spine, discs were allocated to six size-matched groups and to two height-matched groups. The breadth of marginal rims were also measured with a view to provide surgeons operating on the spine with precise data on disc morphology to facilitate disc replacement.     

NECK AND SHOULDER PAIN

Neck and shoulder pains are presenting or incidental symptoms in a large variety of conditions.There may be similarities in the anatomicophysiological mechanism of pain production and in the clinical picture in many of these conditions.Many of the vague and refractory cases of neck and shoulder pain and of migraine may be due to cervical disc disease.Scalenus anticus syndrome and cardiac disease can be diagnosed or differentiated from cervical disc syndrome only by thorough investigation.Proper treatment of neck and shoulder pain is dependent upon correct diagnosis through complete history, physical examination and laboratory tests, as described in this presentation.     

Neck and shoulder pain

Neck and shoulder pains are presenting or incidental symptoms in a large variety of conditions. There may be similarities in the anatomicophysiological mechanism of pain production and in the clinical picture in many of these conditions. Many of the vague and refractory cases of neck and shoulder pain and of migraine may be due to cervical disc disease. Scalenus anticus syndrome and cardiac disease can be diagnosed or differentiated from cervical disc syndrome only by thorough investigation. Proper treatment of neck and shoulder pain is dependent upon correct diagnosis through complete history, physical examination and laboratory tests, as described in this presentation.     

Is the vertebral canal prepared to host the aged spinal cord? A morphometric assessment

Although the interaction between the growing spinal cord and the vertebrae has been widely demonstrated for mammal’s prenatal and early postnatal life, there is no extensive knowledge about this interaction during late postnatal stages. It has been shown that spinal cord injuries are causally related to significant degenerative changes in bone properties. Nevertheless, information about a possible influence of the spinal cord on bone remodelling in adult healthy animals is missing. The aim of this research work was to assess possible morphological changes of the cervical vertebral canal of juvenile and aged rats during the ontogenetic period of adulthood that would justify the suggested influence. Since the spinal cord of rats increases its size with ageing, we analysed whether morphometric changes are occurring in the vertebral canal that would indicate bone remodelling in response to said growth. To this end, we used three complementary morphometric methods to describe the canal of the cervical and the first thoracic vertebrae. Geometric morphometric analyses evidence scarce variation in size and shape between juvenile and aged rats suggesting that, in general terms, the canal morphology of cervical vertebrae is already prepared in early adulthood to host the growing spinal cord. C3 was the only vertebra that showed consistent variation for the variables of canal thickness, perimeter, height and area. This regional variation may be linked to the patterns described for the changing spinal cord.     

Computational analysis of bone remodeling during an anterior cervical fusion

The anterior cervical fusion is an established surgical procedure for spine stabilization after the removal of an intervertebral disc. However, it is not yet clear which bone graft represents the best choice and whether surgical devices can be efficient and beneficial for fusion. The aim of this work is to study the influence of the spine instrumentation on bone remodeling after a cervical spine surgery and, consequently, on the fusion process. A finite element model of the cervical spine was developed, having computed tomography images as input. Bone was modeled as a porous material characterized by the relative density at each point and the bone remodeling law was derived assuming that bone self-adapts in order to achieve the stiffest structure for the supported loads, with the total bone mass regulated by the metabolic cost of maintaining bone tissue. Apart from the analysis of healthy cervical spine, different surgical scenarios were tested: bone graft with or without a cage and the use of a stabilization plate system. Results showed that the anterior and posterior regions of the disc space are more important to stress transmission and that spinal devices reduce bone growth within bone grafts, being plate systems the most interfering elements. The material of the interbody cages plays a major role in fusion and, therefore, it should be carefully chosen.     

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.     

Cercopithecoid cervical vertebral morphology and implications for the presence of Theropithecus in early Pleistocene Europe

While it is recognized that the overall configuration of the vertebral column, as well as the size and shape of individual vertebrae, differ within and between primate taxa, relatively little is known about the degree to which vertebral morphology reflects a phylogenetic signal or the degree to which vertebral elements can be used in accurate taxonomic classification. Isolated vertebrae are occasionally found in fossil assemblages, and proper taxonomic identification is necessary to make inferences about the animal's biology and place it in a broader phylogenetic and evolutionary context. Recently, three large primate cervical vertebrae (C3, C5, and C6) from Pirro Nord, Italy (early Pleistocene, late Villafranchian) were attributed to the genus Theropithecus based on size comparisons with extant cercopithecoid primates (Rook et al., 2004, J. Hum. Evol. 47, 267-277). These fossils were suggested to indicate an early dispersal of this genus out of Africa around 1.6-1.3 Ma possibly co-incident with early Pleistocene dispersals of Homo. Because of the potential importance of these fossils for interpreting Theropithecus evolution and the relatively few morphological data on primate cervical vertebral morphology, we examined the size and shape of cervical vertebrae in a large sample of extant cercopithecoid taxa (n=106). Specifically, we evaluated whether subfamily and genus level assignments can be made on the basis of isolated cervical elements. Discriminant analyses reveal that scaled shape variables are good discriminators of taxonomic affinity at the subfamily level but are poor discriminators at the genus level. Least-squares regressions show that raw linear dimensions of cervical vertebral morphology are good predictors of body mass in the extant sample. Our regression results produce a likely body mass estimate of 22-38 kg for the Pirro Nord cervical vertebrae. Based on these regression estimates, the poor ability to discriminate cervical vertebrae at the genus level, and paleoenvironmental reconstructions of Pirro Nord, it is unlikely that the Pirro Nord fossils can be confidently attributed to the genus Theropithecus. These findings have important implications for recent interpretations of the nature of Theropithecus dispersal out of Africa.     

Vertebral pathology in the afar australopithecines

Ten vertebral elements from the AL-288 partial hominid skeleton and 11 elements from the AL-333 collection are described. The AL-288 column presents a marked kyphosis at the level of thoracic vertebrae 6 through 10, with pronounced new bone formation on the ventral surfaces of these vertebrae. These features, associated with narrowed disc space and minor osteophytosis, resemble Scheuermann disease in the human. Even though this diagnosis is consistent with a basically human, bipedal locomotor repertoire, the presence of Scheuermann disease suggests that lifting, climbing, or acrobatic activities may have been important in early hominids.     

鼋骨骼系统及与中华鳖比较

采用虫蚀法制备了鼋Pelochelys cantorii和中华鳖Pelodiscus sinensis的骨骼标本, 对骨骼系统进行了观察、描述、绘图及比较分析。结果显示, 鼋的骨骼共169枚, 由背甲和腹甲组成的外骨骼、中轴骨和附肢骨组成的内骨骼组成。通过比较鼋和中华鳖的骨骼结构, 发现二者在头骨的吻突长度及第三颈椎结构方面有较大差别。鼋眼眶前部至吻突最前端的长度与头骨总长度比为0.082, 而中华鳖为0.570, 显示中华鳖吻突显著长于鼋。鼋与中华鳖的颈椎骨数目均为9枚, 但中华鳖的第三至第九颈椎的横突要更明显, 第七颈椎的椎体向上显著翘起, 且第九颈椎腹面椎体前端为尖状。从整条颈椎上看, 鼋脊椎长度与其背甲长度之比为0.66, 中华鳖为1.07, 表明中华鳖的颈椎更长; 研究结果丰富了鳖科动物的骨骼学基础数据, 也为鼋物种鉴定、龟鳖动物系统演化及生态适应性提供骨骼学理论依据。     

Congenital malformation of the skeleton in Weiser-Maples guinea pigs]

Some abnormalities were observed in the occipital bone, cervical vertebrae and thoracic vertebrae of Weiser-Maples guinea pigs. In the occipital bone, the medial basilar impression was suggested to occur in 40 (32.8%) out of 122 animals. The basilar impression was classified into right, left and both side types and observed in 24, 11 and 5 animals, respectively. The basilar impression was known to be accompanied in human with some anomalies such as platybasia, Klippel-Feil syndrome, deformation of foramen magnum and so-on. These anomalies were also observed in guinea pigs. The fusion of the axis with the 3rd cervical vertebra was observed in 12 (10.5%) out of 114 animals. The deformation was sometimes observed in the temporal, interparietal, atlas and axis as well as the occipital bone. The fusion of the 7th cervical vertebra with the 1st thoracic vertebra was found in 46 (51.7%) out of 89 animals. This fusion was thought to have no relation with the basilar impression. Weiser-Maples guinea pigs are now in 19 generations of sibmating. Because these abnormalities as mentioned above are all thought to be inherited, the selective breeding will make Weiser-Maples guinea pigs suitable for the study of the basilar impression.     

Chronic arthritis leads to disturbances in the bone collagen network

Introduction

In this study we used a mice model of chronic arthritis to evaluate if bone fragility induced by chronic inflammation is associated with an imbalance in bone turnover and also a disorganization of the bone type I collagen network.

Methods

Serum, vertebrae and femur bones were collected from eight-month-old polyarthritis SKG mice and controls. Strength of the femoral bones was evaluated using three-point bending tests and density was assessed with a pycnometer. Bone turnover markers carboxy-terminal collagen cross-linking telopeptides (CTX-I) and amino-terminal propeptide of type I procollagen (PINP) were measured in serum. The organization and density of bone collagen were analyzed in vertebrae using second-harmonic generation (SHG) imaging with a two-photon microscope and trabecular bone microstructure was assessed by scanning electron microscope (SEM).

Results

Femoral bones of SKG mice revealed increased fragility expressed by deterioration of mechanical properties, namely altered stiffness (P = 0.007) and reduced strength (P = 0.006), when compared to controls. Accordingly, inter-trabecular distance and trabecular thickness as observed by SEM were reduced in SKG mice. PINP was significantly higher in arthritic mice (9.18 ± 3.21 ng/ml) when compared to controls (1.71 ± 0.53 ng/ml, P < 0.001). Bone resorption marker CTX-I was 9.67 ± 3.18 ng/ml in arthritic SKG mice compared to 6.23 ± 4.11 ng/ml in controls (P = 0.176). The forward-to-backward signal ratio measured by SHG was higher in SKG animals, reflecting disorganized matrix and loose collagen structure, compared to controls.

Conclusions

We have shown for the first time that chronic arthritis by itself impairs bone matrix architecture, probably due to disturbed bone remodeling and increased collagen turnover. This effect might predispose patients to bone fragility fractures.     

Evolution of the axial skeleton in armadillos (Mammalia,Dasypodidae)

Intraspecific and interspecific variation in cervical, thoracic, and lumbar region of the vertebral column of Dasypodidae were examined in a phylogenetic framework. The number of vertebrae for each region were recorded for 86 specimens and metric data for each vertebra (centrum length, high, and width) were recorded for 72 specimens, including eight of the nine living genera. The number of vertebrae and degree of fusion between them were used to define four characters which were plotted on two alternative phylogenies of Dasypodidae. The ratio between centrum height and width is similar across all taxa analyzed except for Chlamyphorus, which exhibits a deviation in the last two lumbars. Tolypeutes matacus is unique among the taxa examined in having a second co-osified bone called postcervical bone, which is a fusion of the seventh cervical and first thoracic vertebrae. The thoraco-lumbar numbers of dasypodids are reduced when compared with other xenarthrans and are more diverse than those of some other mammalian clades of similar geological age and higher ecomorphological diversity. Changes in size are somewhat coupled with changes in the number of body segments. Independent of the phylogenetic framework taken, changes in size are accompanied with small changes in numbers of thoracolumbar vertebrae within each genus. There are functional and phylogenetic correlates for changes in number of thoraco-lumbar vertebrae in dasypodids.