经筋推拿治疗颈源性头痛的疗效及对颈椎活动度的影响

目的:探讨经筋推拿治疗颈源性头痛(CEH)的临床疗效,分析其对患者颈椎活动度的影响。方法:选取2017年3月至2017年6月山东省中医院收治的70例CEH患者,按照随机数字表法分为推拿组36例和针刺组34例,推拿组给予经筋推拿治疗,针刺组给予针刺治疗。观察两组治疗前后的疼痛视觉模拟(VAS)评分、头痛积分及颈椎活动度评分,比较两组临床总有效率。结果:推拿组患者治疗后总有效率为97.22%,显著高于针刺组患者82.35%(P0.05)。两组治疗1个疗程后、治疗后1个月的VAS评分、头痛积分、颈椎活动度评分均较治疗前降低,且推拿组低于针刺组(P0.05)。结论:经筋推拿治疗CEH能够缓解疼痛和改善颈椎功能,疗效显著,值得临床推广应用。     

人工颈椎间盘置换与颈前路减压植骨融合术治疗脊髓型颈椎病近期疗效的回顾性研究

摘要 目的：回顾性分析人工颈椎间盘置换（ADR）与颈前路减压植骨融合术（ACDF）治疗脊髓型颈椎病（CSM）的近期疗效。方法：回顾性选取2016年7月~2018年12月期间我院收治的CSM患者120例,上述患者根据手术方式的不同分为A组（n=58,ACDF治疗）和B组（n=62,ADR治疗）,比较两组患者疗效、围术期指标、生活质量简表（SF-12）评分、日本矫形外科协会（JOA）评分、颈椎活动度及并发症发生情况。结果：B组术后12个月的优良率为74.19%（46/62）,高于A组的53.45%（31/58）（P<0.05）。两组患者术后6个月、术后12个月躯体健康评分、精神健康评分均较术前升高,且B组高于A组（P<0.05）。B组术后1个月、术后3个月、术后6个月、术后12个月JOA评分和颈椎活动度均高于A组（P<0.05）。B组住院时间、术后颈托固定时间、术后恢复工作时间均短于A组（P<0.05）。两组术后并发症发生率比较差异无统计学意义（P>0.05）。结论：与ACDF治疗相比,ADR治疗CSM的近期疗效显著,可有效改善患者脊椎功能及生活质量,且安全性较好,临床应用价值较高。     

下颈椎骨折脱位合并急性脊髓损伤的手术方式选择及疗效对比

目的:分析不同手术方式处理下颈椎骨折脱位合并急性脊髓损伤疗效。方法:选取2012年10月-2015年10月本院收治的110例下颈椎骨折脱位合并急性脊髓损伤患者作为研究对象。A组36例实施前路手术,B组44例实施后路手术,C组30例实施前后路联合手术。比较三种手术方式的治疗效果。结果:术后12个月,三组患者Cobb角、椎体水平位移距离均较术前显著改善(P0.05),C组患者改善程度显著高于A、B组(P0.05);C组患者JOA评分优良率显著高于A、B组(P0.05);在术后随访过程中,三组患者并发症总发生情况无统计学差异(P0.05)。结论:前后路联合手术治疗可更好地恢复颈椎解剖结构,促进脊髓神经功能恢复,值得在临床工作中进行推广。     

颈椎康复操对不同类型颈椎病患者康复训练效果的影响

目的:研究三种类型颈椎病患者在康复阶段采用颈椎康复操后的恢复效果。方法:将211例颈椎病患者纳入本次研究,在基础性治疗同时采用颈椎康复操进行康复训练,在训练前以及训练2个月、4个月后,分别检测患者颈部肌肉电生理状况,对其疼痛进行评分。结果:三种类型颈椎病患者的肌肉动作电位峰值、电位传导速度均具有显著统计学意义(P0.05);交感神经型与神经根型患者疼痛评分差异具有统计学意义(P0.05),但混合型患者差异无统计学意义(P0.05)。结论:颈椎康复操对不同类型颈椎病康复训练效果不同,有助于改善患者颈部肌肉运动,但在缓解疼痛方面存在差异,交感神经型、神经根型颈椎病采用颈椎康复操效果较好,但混合型颈椎病效果相对较小。     

山溪鲵的脊柱特征,兼议有尾目脊柱的划分

为探讨有尾目脊椎的划分,本文以小鲵科的山溪鲵(Batrachuperus pinchonii)为例,运用透明骨骼双色法对其脊柱的形态特征进行了观察,并对各部分椎骨特征进行详细描述和绘图.结果显示,山溪鲵的脊椎根据椎骨是否具前关节突、横突、肋骨、肋软骨和脉弓等形态特征可分5部分;同时结合小鲵科其他20种94号标本和蝾螈科6种27号标本的脊柱特征及文献资料,讨论了有尾目脊椎的划分,认为将有尾目脊柱划分为5部分(颈椎、躯椎、荐椎、尾荐椎和尾椎)的观点较将其划分为4部分(颈椎、躯椎、荐椎和尾椎)的观点更合理.     

Silicon compatible with the height of human vertebral column

In the study on human vertebral composites, silicon was found to be related to the height of the vertebral column. The element ratio of silicon to calcium in the lumbar vertebra was twice that of the lowest one in the cervical vertebra. The element ratio gradually increased from approx 0.5 at the cervical vertebra to approx 1.0 at the lumbar one. Silicon is preserved catastropically much more in the lower height of the backbone in contrast with the calcium amount, and the ratio to sulfur appears to be unchanged. This suggests that silicon is compatible with the biokinetics of the vertebral bone structure of calcium.     

中国近海的两种宽吻海豚

本文研究了采自黄海和东海的23件宽吻海豚标本及采自南海的10件南宽吻海豚标本。宽吻海豚体腹面灰白色,成体最小的全长大于2.5米,颅基长495-580毫米。南宽吻海豚体腹面具纵长形暗色点斑,成体最大的全长小于2.5米,颅基长455-497毫米。两者的颅骨和颅后骨胳各有一些差别。中国南海标本的形态性状与南非海域及巴基斯坦沿岸的宽吻海豚相似。黄海和东海标本与东太平洋的标本有一些差别,而与南非及不列颠海域的宽吻海豚标本相似。     

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。     

A New Titanosaurian Sauropod from the Hekou Group (Lower Cretaceous) of the Lanzhou-Minhe Basin,Gansu Province,China

Increased excavation of dinosaurs from China over the last two decades has enriched the record of Asian titanosauriform sauropods. However, the relationships of these sauropods remain contentious, and hinges on a few well-preserved taxa, such as Euhelopus zdanskyi. Here we describe a new sauropod, Yongjinglong datangi gen. nov. et sp. nov., from the Lower Cretaceous Hekou Group in the Lanzhou Basin of Gansu Province, northwestern China. Yongjinglong datangi is characterized by the following unique combination of characters, including seven autapomorphies: long-crowned, spoon-shaped premaxillary tooth; axially elongate parapophyses on the cervical vertebra; very deep lateral pneumatic foramina on the lateral surfaces of the cervical and cranial dorsal vertebral centra; low, unbifurcated neural spine fused with the postzygapophyses to form a cranially-pointing, triangular plate in a middle dorsal vertebra; an “XI”-shaped configuration of the laminae on the arches of the middle dorsal vertebrae; a very long scapular blade with straight cranial and caudal edges; and a tall, deep groove on the lateral surface of the distal shaft of the radius. The new specimen shares several features with other sauropods: a pronounced M. triceps longus tubercle on the scapula and ventrolaterally elongated parapophyses in its cervical vertebra as in Euhelopodidae. Based on phylogenetic analyses Yongjinglong datangi is highly derived within Titanosauria, which suggests either a remarkable convergence with more basal titanosauriform sauropods in the Early Cretaceous or a retention of plesiomorphic features that were lost in other titanosaurians. The morphology and remarkable length of the scapulocoracoid reveal an unusual relationship between the shoulder and the middle trunk: the scapulocoracoid spans over half of the length of the trunk. The medial, notch-shaped coracoid foramen and the partially fused scapulocoracoid synostosis suggest that the specimen is a subadult individual. This specimen sheds new light on the diversity of Early Cretaceous Titanosauriformes in China.     

Mid-sagittal dimensions of cervical vertebral bodies.

A series of lateral radiographs of the cervical spinal column was evaluated in order to determine vertebral body dimensions. The sample included males (N=30) and females (N=31) 18 to 24 years old, comprising three stature percentile ranges (1-20; 40-60; 80-99) of the U.S. adult population. A two-dimensional analysis of vertebral body height (average distance between superior-inferior surgaces), depth (average distance between anteriorposterior surfaces), and area (average height X average depth) revealed minimal effects due to stature. In all subjects, average depth exceeded average height for vertebral bodies C3 through C7. Upon combining stature groups, both sexes revealed maximum average values for these dimensions at the seventh cervical vertebral body. Minimum average height occurred at C5 whereas minimum average depth was found at C3. Significant correlation (alpha greater than 0.05) was found for males between ponderal index and height and depth of the C7 vertebra. Male head weight correlated significantly with C3, C4, C5 and C6 vertebral body height and with C3, C5 and C6 vertebral body depth. For females, C7 height and C6 depth correlated significantly with ponderal index and head weight respectively. Probable biomechanical relationships of specific cervical vertebral bodies are noted     

A partial skeleton of Prodeinotherium bavaricum (Proboscidea, Mammalia) from the Middle Miocene of Unterzolling (Upper Freshwater Molasse, Germany)

Here, a partial skeleton of Prodeinotherium bavaricum from Unterzolling (Southern Germany) is documented. The following elements are preserved and described for the first time: cervical vertebrae 1-2 and 5-7, the first thoracic vertebra, one lumbar vertebra, trapezium, metacarpals 1-5, tibia, calcaneus, endo- and mesocuneiform, cuboid, the fourth metatarsal, and some phalanges. Comparisons with the skeletons of P. bavaricum from Franzensbad (Czech Republic) and Deinotherium giganteum from Eserovo (Bulgaria) show osteological differences that are described and discussed.     

Biomedical engineers present a futuristic wonderland of new devices — and all in the real world

Three patients with the droopy shoulder syndrome are described. This condition occurs most often in young women who are mildly or moderately depressed. Their shoulders are painful and the only clinical sign is drooping of the shoulders. There are no signs of neurologic abnormality. A lateral radiograph of the cervical spine shows all seven cervical vertebrae, the first thoracic vertebra and part or all of the second thoracic vertebra.     

活血通络汤联合卧位平衡手法治疗椎动脉型颈椎病的疗效及对动脉血流速度的影响

目的:研究活血通络汤联合卧位平衡手法治疗椎动脉型颈椎病(CSA)的疗效及对动脉血流速度的影响。方法:选取2015年10月-2017年6月佛山市中医院推拿科收治的CSA患者105例作为研究对象。将其以随机抽签原则分成观察组(n=53)以及对照组(n=52)。对照组予以盐酸氟桂利嗪胶囊口服治疗,观察组则在对照组的基础上予以活血通络汤联合卧位平衡手法治疗,两组均进行为期4周的治疗。比较两组临床疗效、治疗前后临床症状与颈椎功能变化情况、动脉血流速度以及颈椎屈伸活动情况。结果:观察组治疗总有效率为98.11%,高于对照组的88.46%,差异有统计学意义(P0.05)。治疗后两组患者临床症状以及颈椎功能各项评分均高于治疗前,且观察组高于对照组,差异有统计学意义(P0.05)。治疗后两组患者左椎动脉、右椎动脉的舒张期血流速度(Vd)、收缩期血流速度(Vs)均高于治疗前,且观察组高于对照组,差异有统计学意义(P0.05)。治疗后两组患者颈椎曲度、颈椎屈伸活动度均高于治疗前,且观察组高于对照组,差异有统计学意义(P0.05)。结论:活血通络汤联合卧位平衡手法治疗CSA的疗效较好,有利于缓解患者临床症状,改善动脉血流速度以及颈椎病理状况。     

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.     

Why do almost all mammals have seven cervical vertebrae? Developmental constraints, Hox genes, and cancer.

Mammals have seven cervical vertebrae, a number that remains remarkably constant. I propose that the lack of variation is caused by developmental constraints: to wit, changes in Hox gene expression, which lead to changes in the number of cervical vertebrae, are associated with neural problems and with an increased susceptibility to early childhood cancer and stillbirths. In vertebrates, Hox genes are involved in the development of the skeletal axis and the nervous system, among other things. In humans and mice, Hox genes have been shown also to be involved in the normal and abnormal (cancer) proliferation of cell lines; several types of cancer in young children are associated with abnormalities in Hox gene expression and congenital anomalies. In these embryonal cancers the incidence of a cervical rib (a rib on the seventh cervical vertebra, a homeotic transformation of a cervical vertebra towards a thoracic-type vertebra) appears to be increased. The minimal estimate of the selection coefficient acting against these mutations is about 12%. In birds and reptiles variations in the number of cervical vertebrae have frequently occurred and there is often intraspecific variability. A review of the veterinary literature shows that cancer rates appear lower in birds and reptiles than in mammals. The low susceptibility to cancer in these classes probably prevents the deleterious pleiotropic effect of neonatal cancer when changes in cervical vertebral number occur. In mammals there is, thus, a coupling between the development of the axial skeleton and other functions (including the proliferations of cell lines). The coupling of functions is either a conserved trait that is also present in reptiles and birds, but without apparent deleterious effects, or the coupling is new to mammals due to a change in the functioning of Hox genes. The cost of the coupling of functions in mammals appears to be an increased risk for neural problems, neonatal cancer, stillbirths, and a constraint on the variability of cervical vertebral number.     

Neuronal labeling patterns in the spinal cord of adult transgenic Zebrafish

We describe neuronal patterns in the spinal cord of adult zebrafish. We studied the distribution of cells and processes in the three spinal regions reported in the literature: the 8th vertebra used as a transection injury site, the 15th vertebra mainly used for motor cell recordings and also for crush injury, and the 24th vertebra used to record motor nerve activity. We used well‐known transgenic lines in which expression of green fluorescent protein (GFP) is driven by promoters to hb9 and isl1 in motoneurons, alx/chx10 and evx1 interneurons, ngn1 in sensory neurons and olig2 in oligodendrocytes, as well as antibodies for neurons (HuC/D, NF and SV2) and glia (GFAP). In isl1:GFP fish, GFP‐positive processes are retained in the upper part of ventral horns and two subsets of cell bodies are observed. The pattern of the transgene in hb9:GFP adults is more diffuse and fibers are present broadly through the adult spinal cord. In alx/chx10 and evx1 lines we respectively observed two and three different GFP‐positive populations. Finally, the ngn1:GFP transgene identifies dorsal root ganglion and some cells in dorsal horns. Interestingly some GFP positive fibers in ngn1:GFP fish are located around Mauthner axons and their density seems to be related to a rostrocaudal gradient. Many other cell types have been described in embryos and need to be studied in adults. Our findings provide a reference for further studies on spinal cytoarchitecture. Combined with physiological, histological and pathological/traumatic approaches, these studies will help clarify the operation of spinal locomotor circuits of adult zebrafish. © 2015 Wiley Periodicals, Inc. Develop Neurobiol 76: 642–660, 2016     

Evaluation of "unique" aspects of human vertebral bodies and pedicles with a consideration of Australopithecus africanus

Recent functional studies of human vertebrae have revealed that loads borne by the axial skeleton during bipedal postures and locomotion pass through the pedicles and posterior elements as well as through the bodies and discs. Accordingly, particular morphological attributes of these vertebral elements have been linked exclusively with bipedalism. In order to test the validity of current form-function associations in human vertebral anatomy, this study considers the morphology of human thoracolumbar vertebral bodies and pedicles in the context of a wide comparative primate sample. The last lumbar vertebra of STS 14 (Australopithecus africanus) is also included in the analysis. Results indicate that certain features of human vertebrae previously thought to reflect bipedalism are characteristic of several nonhuman primates, including those whose posture is habitually pronograde. These features include the decrease in vertebral body surface area and the increase in cross-sectional area of the pedicle between the penultimate and last lumbar vertebra. In addition, although humans have relatively large and wide last lumbar pedicles, the enlargement and widening of the pedicle between the penultimate and last lumbar vertebra is not unique to humans. On the other hand, human vertebrae do exhibit several unique adaptations to bipedal posture and locomotion: (1) the vertebral body surface areas of the lower lumbar vertebrae and the cross-sectional areas of the last lumbar pedicles are large relative to body size, and (2) the last lumbar pedicles are wider relative to length and to body size than are those of nonhuman primates. The last lumbar vertebra of STS 14 does not exhibit any of these human-like vertebral features—its pedicles and body surface areas are relatively small, and its pedicles are not relatively wide, but relatively short.     

Reaction of a human head/neck/torso system to shock

The purpose of this study is to predict human response to, and potential damage from, impact loading by using numerical and physical models to monitor the head and thoracic reactions, intervertebral disk pressures, muscle elongations, and some internal organ pressures. The numerical model consists of a three-dimensional lumped-parameter system of ten rigid bodies connected by nine intervertebral joints and 28 muscle pairs. The masses represent the head; cervical vertebrae C1-C2, C3-C4, C5-C6, C7-T1 (the first thoracic vertebra); the entire thorax; lumbar vertebrae L1-L2, L3, L4-L5; and the pelvis. The physical model consists of: a water-filled cadaver skull, held in position by attached ligaments; plastic skeletal components involving vertebrae, sternum, ribs and pelvis; silicon rubber intervertebral disks; fabric muscles and ligaments; and water-filled containers replicating the liver, spleen and kidneys. The pelvis of the model is affixed to a plate mounted on a sled that runs on a track. Loading is applied by deceleration from a given velocity that occurs due to the impact of the sled with a fixed aluminum block. Results from the numerical model are compared with corresponding experimental information from the physical structure. Good correlation was obtained in these comparisons up to about 200-250 ms after impact. The results indicate that the head, cervical muscles and disks in the lumbar region are subjected to the greatest force changes and thus are most likely to be injured.     

Comparison of Cervical Spine Anatomy in Calves,Pigs and Humans

Background Context

Animals are commonly used to model the human spine for in vitro and in vivo experiments. Many studies have investigated similarities and differences between animals and humans in the lumbar and thoracic vertebrae. However, a quantitative anatomic comparison of calf, pig, and human cervical spines has not been reported.

Purpose

To compare fundamental structural similarities and differences in vertebral bodies from the cervical spines of commonly used experimental animal models and humans.

Study Design

Anatomical morphometric analysis was performed on cervical vertebra specimens harvested from humans and two common large animals (i.e., calves and pigs).

Methods

Multiple morphometric parameters were directly measured from cervical spine specimens of twelve pigs, twelve calves and twelve human adult cadavers. The following anatomical parameters were measured: vertebral body width (VBW), vertebral body depth (VBD), vertebral body height (VBH), spinal canal width (SCW), spinal canal depth (SCD), pedicle width (PW), pedicle depth (PD), pedicle inclination (PI), dens width (DW), dens depth (DD), total vertebral width (TVW), and total vertebral depth (TVD).

Results

The atlantoaxial (C1–2) joint in pigs is similar to that in humans and could serve as a human substitute. The pig cervical spine is highly similar to the human cervical spine, except for two large transverse processes in the anterior regions ofC4–C6. The width and depth of the calf odontoid process were larger than those in humans. VBW and VBD of calf cervical vertebrae were larger than those in humans, but the spinal canal was smaller. Calf C7 was relatively similar to human C7, thus, it may be a good substitute.

Conclusion

Pig cervical vertebrae were more suitable human substitutions than calf cervical vertebrae, especially with respect to C1, C2, and C7. The biomechanical properties of nerve vascular anatomy and various segment functions in pig and calf cervical vertebrae must be considered when selecting an animal model for research on the spine.     

Bilateral Thoracic Outlet Syndrome from Anomalous 8th Cervical Vertebrae Ribs

Thoracic outlet syndrome (TOS) is a group of diverse disorders resulting from compression of neurovascular structures as they pass from the lower neck to upper limb. Neurological symptoms, such as pain, weakness, or paraesthesia, are much more common than vascular symptoms such as pallor or venous congestion. Anatomical abnormalities can contribute to this condition. Thirty percent of patients with TOS can have a cervical rib, arising from the transverse process of the 7th cervical vertebra, compared with 1% of the general population. We report the first case in the literature of neurogenic TOS from a cervical rib arising from a supernumerary 8th cervical vertebra. This patient had immediate improvement in TOS symptoms following scalene muscle surgery and resection of cervical and first thoracic ribs.