20例葡萄球菌感染所致化脓性脊柱炎的临床特征分析

为探讨葡萄球菌感染所致化脓性脊柱炎(pyogenic vertebral osteomyelitis,PVO)的临床及影像学特征,本研究回顾性分析了2009年1月-12月上海交通大学附属第六人民医院感染病科收治的20例葡萄球菌感染所致PVO患者的临床特征、实验室检查指标、影像学资料及治疗效果。结果显示,20例PVO患者中金黄色葡萄球菌感染较为多见,85%患者病变在腰椎,50%患者白细胞计数升高,13例发热(65%),12例(60%)出现椎旁脓肿,所有患者C反应蛋白、红细胞沉降率、铁蛋白均升高。计算机断层扫描(computed tomography,CT)平扫示感染椎体骨质破坏;磁共振成像(magnetic resonance imaging,MRI)示病变椎体及椎间盘破坏区异常信号灶,增强后可见明显强化;单光子发射计算机断层扫描(emission computed tomography,ECT)示病变椎体不均匀放射性摄取增高。金黄色葡萄球菌对青霉素耐药率达77.8%。12例椎旁脓肿患者经CT引导下穿刺置管引流加敏感抗生素治疗,临床结局良好。结果提示,金黄色葡萄球菌是葡萄球菌感染所致PVO的主要致病菌,其对青霉素普遍耐药,炎症指标和影像学检查可用于疗效评估及随访,内科保守治疗对PVO有效。     

Evidence of Spondyloarthropathy in the Spine of a Phytosaur (Reptilia: Archosauriformes) from the Late Triassic of Halberstadt,Germany

Pathologies in the skeleton of phytosaurs, extinct archosauriform reptiles restricted to the Late Triassic, have only been rarely described. The only known postcranial pathologies of a phytosaur are two pairs of fused vertebrae of “Angistorhinopsis ruetimeyeri” from Halberstadt, Germany, as initially described by the paleontologist Friedrich von Huene. These pathologic vertebrae are redescribed in more detail in this study in the light of modern paleopathologic methods. Four different pathologic observations can be made in the vertebral column of this individual: 1) fusion of two thoracic vertebral bodies by new bone formation within the synovial membrane and articular capsule of the intervertebral joint; 2) fusion and conspicuous antero-posterior shortening of last presacral and first sacral vertebral bodies; 3) destruction and erosion of the anterior articular surface of the last presacral vertebra; and 4) a smooth depression on the ventral surface of the fused last presacral and first sacral vertebral bodies. Observations 1–3 can most plausibly and parsimoniously be attributed to one disease: spondyloarthropathy, an aseptic inflammatory process in which affected vertebrae show typical types of reactive new bone formation and erosion of subchondral bone. The kind of vertebral shortening present in the fused lumbosacral vertebrae suggests that the phytosaur acquired this disease in its early life. Observation 4, the smooth ventral depression in the fused lumbosacral vertebrae, is most probably not connected to the spondyloarthropathy, and can be regarded as a separate abnormality. It remains of uncertain origin, but may be the result of pressure, perhaps caused by a benign mass such as an aneurysm or cyst of unknown type. Reports of spondyloarthropathy in Paleozoic and Mesozoic reptiles are still exceptional, and our report of spondyloarthropathy in fossil material from Halberstadt is the first unequivocal occurrence of this disease in a Triassic tetrapod and in a phytosaur.     

Carpal tunnel syndrome,humeral epicondylitis,and the cervical spine: a study of clinical and dimensional relations.

Forty-three patients with idiopathic carpal tunnel syndrome, confirmed by nerve conduction studies and treated by surgery, were compared clinically and radiologically with 43 age- and sex-matched control patients. Patients with carpal tunnel syndrome had a significantly greater prevalence of lateral humeral epicondylitis (tennis elbow) (33%) than controls (7%). Randomised reading of the cervical spine radiographs in ignorance of the groups to which they belonged showed no significant difference in the prevalence of either intervertebral disc degeneration or intraforaminal osteophyte protruion using conventional grading methods. Measurement of the minimum anteroposterior diameter of the cervical spinal canal, the anteroposterior diameters of the cervical vertebral bodies, and the ratio of intervertebral disc height to adjacent vertebral body height in the cervical spine, however, showed a consistent trend to smaller measurements in the carpal tunnel group. Differences were significant at several vertebral levels in each of these dimensions. The narrowing of the intervertebral discs relative to the vertebral bodies in patients with carpal tunnel syndrome may indicate connective tissue changes, which might also occur in the common extensor origin at the elbow or in the contents of the carpal tunnel.     

Changes in the intervertebral disks in disorders of segmental blood supply of the spine

In 50 mature Chinchilla rabbits a model of chronic insufficiency of blood supply in the lumbar vertebral bodies has been disturbed as a result of unilateral sectioning of the segmentary arteries and veins. By means of light and transmissive electron microscopy the dynamics of structural changes has been followed in tissue of the intervertebral discs for 3 months after the operative intervention. Under hypoxia in the ground substance of the pulposus++ nucleus even proteoglycans granular-filamentous network gradually develops and floccular material and transverse striated filamentous aggregates are accumulated. Notochord cells are subjected to certain degenerative changes and die. Simultaneously fibroblastic cells of the pulposus++ nucleus periphery become activated, they produce glycosaminoglycans and collagen. As a result the hydrated tissue of the pulposus++ nucleus is substituted for a newly formed fibrous cartilage. The process of fibroses in the intervertebral disc is completed in 3 months after blood circulation has been disturbed in the vertebral bodies.     

Fusion of the cervical vertebrae of mammals

Morphogenesis of the cervical vertebrae has been investigated in Dipis sagitt. and in Rattus norvegicus. The main distinctive feature of the Dipis embryos at the mesenchymal stage is their very thin perichordal intervertebral rings. As a result, short cartilaginous vertebral bodies and thin intervertebral discs develop, cervical segments lengthen more slowly than those of the Rattus. Because of the small length of the Dipis cervical segments, the cartilaginous neural arches and the transverse processes of 2-6 vertebrae draw nearer and fuse. Owing to the insufficient development of the Dipis intervertebral discs and the nuclei pulposae, the normal formation of the vertebral epiphyses is disturbed, this results in fusion of the neighbouring osseous vertebral bodies.     

The arterial supply of the thoracic and lumbar spine in newborns

The major arteries supplying the vertebral column are definite. The branching arteries of these trunks are variable. The posterior intercostal arteries and the lumbar arteries have an ascending, descending or horizontal course. In accordance with the literature, we found large, arched anastomoses between the rami ascendentes and the rami descendentes arising from the rami canalis vertebralis anteriores on the dorsal plane of the vertebral bodies. There are also nearly horizontal junctions between the rr. ascendentes of both sides. We found junctions on the front of the thoracolumbar vertebral column at the end of the arteries. On the dorsal plane of the vertebral body 2 arteriae centrales posteriores originate from the rr. ascendentes. They run to the centre of the vertebral body. On the ventrolateral plane of the vertebral body 2 or 3 aa. centrales anteriores can be found. These 4 or 5 arteries join in the middle of the vertebral body. The blood supply of the thoracal and lumbar vertebral bodies does not differ essentially. Vessels come especially from lateral in the intervertebral disc. We suggest to name such a vessel ramus disci intervertebralis. The posterior longitudinal ligament is mainly supplied by the junction between the rr. ascendentes of both sides and the anterior longitudinal ligament by the aa. nutriciae in the thoracal and the lumbar area.     

Characteristics and structural variants of human lumbar intervertebral disks]

By means of macro- and microscopical methods structure of 412 lumbar intervertebral discs (ID), obtained from 84 corpses of persons died at the age 16-90 years have been studied, as well as 30 macerated lumbar vertebra. During these periods the lumbar ID are formed by hyalin laminae and a connective tissue wall, surrounding the cavity. According to the tissue type, in the ID wall three main layers are differentiated. The external layer is determined as a fibrous ring, the middle one--as fibrous-cartilagenous and the internal one--as a chondromucoid ring. The three layers gradually and consequently turn one into another. According to manifestation degree of these layers, development of the internal layer and size of the cavity three main variants of the ID structure are nominated: intervertebral synarthrosis, intervertebral hemiarthrosis and intervertebral "diathrosis" (real articulations have not been revealed between the vertebral bodies). The occurrence rate of the ID structural variants revealed in the lumbar part of the spinal cord is demonstrated. Absence of chordal mucous in the cavity is specific for the ID during the age periods investigated. The role of the "nucleus" is performed by the internal layer of the ID wall, which possesses a system of processes and a forming peculiar pulpous complex, which ensures the ID adaptation to various changes in position of the vertebral locomotor segment. The pulpous complex is surrounded with a united fibrillar carcass of hyalin laminae and fibrous-cartilagenous ring; together with the carcass it forms an elastic layer between the vertebral bodies.     

Compressed vertebrae in Atlantic salmon Salmo salar: evidence for metaplastic chondrogenesis as a skeletogenic response late in ontogeny

Anterior/posterior (a/p) compression of the vertebral column, referred to as 'short tails', is a recurring event in farmed Atlantic salmon. Like other skeletal deformities, the problem usually becomes evident in a late life phase, too late for preventive measures, making it difficult to understand the aetiology of the disease. We use structural, radiological, histological, and mineral analyses to study 'short tail' adult salmon and to demonstrate that the study of adult fish can provide important insights into earlier developmental processes. 'Short tails' display a/p compressed vertebrae throughout the spine, except for the first post-cranial vertebrae. The vertebral number is unaltered, but the intervertebral space is reduced and the vertebrae are shorter. Compressed vertebrae are characterized by an unchanged central part, altered vertebral end plates (straight instead of funnel-shaped), an atypical inward bending of the vertebral edges, and structural alterations in the intervertebral tissue. The spongiosa is unaffected. The growth zones of adjacent vertebrae fuse and blend towards the intervertebral space into chondrogenic tissue. This tissue produces different types of cartilage, replacing the notochord. The correspondence in location of intervertebral cartilage and deformed vertebral end plates, and the clearly delimited, unaltered, central vertebral parts suggest that the a/p compression of vertebral bodies is a late developmental disorder that may be related to a metaplastic shift of osteogenic tissue into chondrogenic tissue in the vertebral growth zone. Given the lack of evidence for infections, metabolic disorders and/or genetic disorders, we propose that an altered mechanical load could have caused the transformation of the bone growth zones and the concomitant replacement of the intervertebral (notochord) tissue by cartilaginous tissues in the 'short tails' studied here. This hypothesis is supported by the role that notochord cells are known to play in spine development and in maintaining the structure of the intervertebral disk.     

The elongation of the human cervical vertebral column

Cervical vertebral elongation has been studied using serial cephalometric radiographs of 32 children examined regularly from 0.25 to 17 years. Mean vertebral body heights increased rapidly to about 2.5 years and then decelerated except for a spurt at about the age of peak height velocity. There were only small sex differences in vertebral body elongation to 12 years. From then to 15 years, the vertebral body heights in the girls exceeded those in the boys; later this sex difference was reversed. There was no pubertal spurt in disc elongation. The correlation coefficients were negative between vertebral body heights and the heights of adjoining intervertebral discs, e.g., body C3 and disc C3–4, but those between body heights or between disc heights were positive. The heights of adjacent cervical vertebral bodies were correlated more highly than the heights of non-adjacent bodies. There was a similar pattern of differences between correlation coefficients for the heights of adjacent and non-adjacent intervertebral discs.     

Notochord-dependent expression of MFH1 and PAX1 cooperates to maintain the proliferation of sclerotome cells during the vertebral column development.

During axial skeleton development, the notochord is essential for the induction of the sclerotome and for the subsequent differentiation of cartilage forming the vertebral bodies and intervertebral discs. These functions are mainly mediated by the diffusible signaling molecule Sonic hedgehog. The products of the paired-box-containing Pax1 and the mesenchyme forkhead-1 (Mfh1) genes are expressed in the developing sclerotome and are essential for the normal development of the vertebral column. Here, we demonstrate that Mfh1 like Pax1 expression is dependent on Sonic hedgehog signals from the notochord, and Mfh1 and Pax1 act synergistically to generate the vertebral column. In Mfh1/Pax1 double mutants, dorsomedial structures of the vertebrae are missing, resulting in extreme spina bifida accompanied by subcutaneous myelomeningocoele, and the vertebral bodies and intervertebral discs are missing. The morphological defects in Mfh1/Pax1 double mutants strongly correlate with the reduction of the mitotic rate of sclerotome cells. Thus, both the Mfh1 and the Pax1 gene products cooperate to mediate Sonic hedgehog-dependent proliferation of sclerotome cells.     

Study in situ et in vivo of the acceleration of lumbar vertebrae of a primate exposed to vibration in the Z-axis

In order to study the propagation of vibration along the spine, the authors developed a method allowing in vivo et in situ measurement of vibrational accelerations in the lower lumbar spine of a primate.

The surgical technique used to anchor the miniature accelerometers on the anterior wall of vertebral bodies is described. After recovery, the sitting animal is exposed to a vibration stimulus. Direct recording of data obtained from the lowest four lumbar vertebrae of a healthy live animal provide objective information on the behavior of intervertebral discs and will later permit definition of the role of skeletal muscles in the spinal response to a vibrational stress.     

Built for speed: strain in the cartilaginous vertebral columns of sharks

In most bony fishes vertebral column strain during locomotion is almost exclusively in the intervertebral joints, and when these joints move there is the potential to store and release strain energy. Since cartilaginous fishes have poorly mineralized vertebral centra, we tested whether the vertebral bodies undergo substantial strain and thus may be sites of energy storage during locomotion. We measured axial strains of the intervertebral joints and vertebrae in vivo and ex vivo to characterize the dynamic behavior of the vertebral column. We used sonomicrometry to directly measure in vivo and in situ strains of intervertebral joints and vertebrae of Squalus acanthias swimming in a flume. For ex vivo measurements, we used a materials testing system to dynamically bend segments of vertebral column at frequencies ranging from 0.25 to 1.00 Hz and a range of physiologically relevant curvatures, which were determined using a kinematic analysis. The vertebral centra of S. acanthias undergo strain during in vivo volitional movements as well as in situ passive movements. Moreover, when isolated segments of vertebral column were tested during mechanical bending, we measured the same magnitudes of strain. These data support our hypothesis that vertebral column strain in lateral bending is not limited to the intervertebral joints. In histological sections, we found that the vertebral column of S. acanthias has an intracentral canal that is open and covered with a velum layer. An open intracentral canal may indicate that the centra are acting as tunics around some sections of a hydrostat, effectively stiffening the vertebral column. These data suggest that the entire vertebral column of sharks, both joints and centra, is mechanically engaged as a dynamic spring during locomotion.     

Developmental characteristics of the human lumbar spinal column at various periods of ontogeny

Regularities in development and differentiation of vertebrae have been investigated according to ageing. The data concerning the size of the vertebral canal at the level of the lumbar vertebral bodies and intervertebral discs, intensity of increase of these dimensions in various age periods, the character of spatial relations of sizes and form of the canal has been analysed. The transversal section area of the canal and the body in the corresponding segment varies between 1:3 and 1:5.5. By means of x-ray osteophotometry the mineralization degree of the lumbar vertebral bodies has been determined in men of various age. An important fact has been stated on a close connection between mineral saturation in juvenile and first mature ages with induces of general strength.     

Ventral approach to the lumbar spine of the Sprague-Dawley rat

Lumbar intervertebral disc repair is an important tissue-engineering research area. In creating an in vivo rat model to evaluate repair techniques, the authors developed a surgical transperitoneal approach that permits the easy exposure of four lumbar vertebral bodies with no surgery-related peri- or postoperative complications.     

Contribution of vertebral [corrected] bodies, endplates, and intervertebral discs to the compression creep of spinal motion segments

Spinal segments show non-linear behavior under axial compression. It is unclear to what extent this behavior is attributable to the different components of the segment. In this study, we quantified the separate contributions of vertebral bodies and intervertebral discs to creep of a segment. Secondly, we investigated the contribution of bone and osteochondral endplate (endplates including cartilage) to the deformation of the vertebral body. From eight porcine spines a motion segment, a disc and a vertebral body were dissected and subjected to mechanical testing. In an additional test, cylindrical samples, machined from the lowest thoracic vertebrae of 11 porcine spines, were used to compare the deformation of vertebral bone and endplate. All specimens were subjected to three loading cycles, each comprising a loading phase (2.0 MPa, 15 min) and a recovery phase (0.001 MPa, 30 min). All specimens displayed substantial time-dependent height changes. Average creep was the largest in motion segments and smallest in vertebral bodies. Bone samples with endplates displayed substantially more creep than samples without. In the early phase, behavior of the vertebra was similar to that of the disc. Visco-elastic deformation of the endplate therefore appeared dominant. In the late creep phase, behavior of the segment was similar to that of isolated discs, suggesting that in this phase the disc dominated creep behavior, possibly by fluid flow from the nucleus. We conclude that creep deformation of vertebral bodies contributes substantially to creep of motion segments and that within a vertebral body endplates play a major role.     

PKP治疗骨质疏松性椎体压缩骨折的预后评价及继发危险因素分析

目的:分析椎弓根入路行椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折的预后评价及继发危险因素分析。方法:选择2016年2月-2018年2月我院收治的骨质疏松性椎体压缩骨折患者85例纳入本次研究,采用随机数表法分为观察组(n=43)和对照组(n=42)。对照组使用经皮椎体成形术进行治疗,观察组采用PKP进行治疗。比较两组患者手术情况、术后情况、椎体前缘高度丢失率、Cobb角、继发性骨折发生情况及分析骨质疏松性椎体压缩骨折患者术后继发骨折的危险因素。结果:观察组手术时间、透视次数、骨水泥注入量、术中出血量均显著低于对照组,差异显著(P0.05);观察组疼痛缓解时间、下地时间及住院时间均显著低于对照组,差异显著(P0.05);治疗前,两组椎体前缘高度丢失率、Cobb角比较,无显著差异;治疗后,两组患者的椎体高度丢失率明显下降,但两组术后7 d、术后6月两组椎体前缘高度丢失率、Cobb角比较无显著差异;观察组术后12月椎体前缘高度丢失率、Cobb角低于对照组,差异显著(P0.05);所有患者均随访12月,其中22例(25.88%)发生继发性椎体骨折,进行单因素分析,结果发现,两组患者性别、骨折部位、局部矢状面后凸角度、骨水泥量、椎体高度恢复、术后抗骨质疏松治疗差异无统计学意义(P0.05);骨质疏松原因、骨水泥椎间隙渗漏、术后支具佩戴、原发骨折类型与骨质疏松性椎体压缩骨折患者术后发生继发骨折相关(P0.05)。多因素Logistic分析显示,骨质疏松原因、骨水泥椎间隙渗漏、术后支具佩戴、原发骨折类型均是骨质疏松性椎体压缩骨折患者术后发生继发骨折的独立危险因素(P0.05)。结论:在骨质疏松性椎体压缩骨折患者中应用PKP可有效改善手术情况,随着时间的延长,PKP更有利于维持患者椎体高度;骨质疏松原因、骨水泥椎间隙渗漏、术后支具佩戴、原发骨折类型是骨质疏松性椎体压缩骨折患者术后发生继发骨折的危险因素,临床上对于具有危险因素的患者引起重视,并采取干预措施。     

Computed tomography in the diagnosis of degenerative diseases of the spine

CT and roentgenography were used for the investigation of 78 patients with the radicular syndrome. The state of the intervertebral disks, intervertebral joints and cerebrospinal canal in degenerative vertebral diseases was assessed. CT permits the detection of hernia, protrusion of the intervertebral disks, deformity of the intervertebral joints, and the narrowing of the cerebrospinal canal as a result of degenerative changes, as well as establishing the cause of the affection of neural structures in the cerebrospinal canal, radicular holes. CT possesses some advantages over roentgenography in the diagnosis of degenerative vertebral diseases and can be recommended as the principal method together with roentgenography for investigation of patients with lumbar pains.     

单侧PKP术对骨质疏松压缩性骨折相邻椎体高度的影响

目的：探讨单一椎体骨质疏松性压缩性骨折行单侧PKP 术后对相邻上下椎体高度的影响。方法：62 例行T12 椎体骨质疏松 性压缩性骨折单侧PKP 术后的患者,测量术前,术后2 天、6 个月、1 年T11 椎体及L1 椎体前缘、中央及后缘高度,计算椎体压缩 率,比较两椎体各时相点椎体前缘、中央及后缘椎体压缩率的变化。结果：术后2 天L1 和T11 的椎体前缘、中央及后缘压缩率比 较差异无统计学意义(P 均>0.05);术后6 个月、1 年后两椎体前缘、中央及后缘高度压缩率比较（P均<0.05）差异有统计学意义。 L1 和T11 术后2 天、6 个月、12 个月不同时相,三点压缩率越来越大,差异有统计学意义(P均<0.05)。结论：单侧PKP术后椎体相 应负荷的改变,对下位邻近椎体较上位椎体高度影响较大,可能与相邻下位椎体承受的重力高于上位相邻椎体有关。     

A case with spondylo-metaphyseal dysplasia type A4

We present a case with spondylo-metaphyseal dysplasia type A4 characterized by ovoid vertebral bodies with anterior tongue-like deformities, widened irregular and sclerotic metaphyseal changes, short iliac wings, slightly short long bones and short tubular bones of the hands with irregular metaphyses. She also had bipartite trochlea and irregular patellar margins, which have not been described in spondylo-metaphyseal dysplasia types to date.     

Validation of single-segment and three-segment spinal models used to represent lumbar flexion

Changes in spinal posture between the erect and flexed positions were calculated using angular measurements from lateral photographs and radiographs of ten adult male subjects. For photographic measurements, the thoracolumbar vertebral column was modelled as either a single segment or as three segments. In the three-segment model, there was a non-significant correlation between the decrease in lumbar concavity and intervertebral motion. In addition, there was a non-significant negative correlation between the increase in thoracic convexity and lumbar motion determined radiographically. In the single-segment model, the decrease in angulation between the thoracolumbar spine and pelvis was a good representation of lumbar spine flexion as determined by the mean lumbar intervertebral angular change. Therefore, modelling the thoracolumbar vertebral column as a single segment allowed better estimation of lumbar intervertebral angular change during flexion than a three-segment model. The results indicate that large range dynamic motion of the lumbar vertebral column can be represented using photographic analysis of the positions of three easily identified anatomical landmarks: the anterior superior iliac spine, posterior superior iliac spine and the spinous process of the first thoracic vertebra.