椎关节

Results In 84 cases of nerve root type,stenosis was found in 438 intervertebral foramen,of which C6～7 and C5～6 intervertebral foramen stenosis accounted for 79.6%.The causes of intervertebral foramen stenosis were uncinate process articulation hyperosteogeny,intervenebral disc protrusion,vertebral body hypertrophy,zygapophysis hyperosteogeny and dislocation etc.40 cases of vertbral artery type manifested that vertbral artery became slim and deviousness as a result of the compression of vertbral artery （20.7%） by osteophyte.22 cases of myeloid type manifested with cervical spinal canal stenosis,hyperosteogeny of posterior vertebral body edge,posterior longitudinal ligament calcification and cervical intervertebral disc protrusion etc.

结果 84例神经根型中，发现椎间孔狭窄438处，其中C5～6和C6～7椎间孔狭窄占79.6%，椎间孔狭窄的成因有钩突关节骨质增生、椎间盘突出、椎体肥大、小关节突骨质增生、错位等；40例椎动脉型表现为骨赘压迫椎动脉（52.5%），导致椎动脉变细、粗细不均和椎动脉迂曲。22例脊髓型表现为颈椎椎管狭窄、椎体后缘骨质增生、后纵韧带钙化、椎间隙狭窄和颈椎间盘突出等。

Results: Among 32 cases, abnormality of vertebral artery was found in 31 cases, abnormality of transverse foramen was found in 6 cases, hyperplasia of Luschka joint were found in 20 cases.

结果： 32例患者中有椎动脉异常表现者31例，横突孔异常者6例，钩椎关节增生者20例。

The front suture width of axis and atlas joints and the shift degree of dens were also measured.results: 13 cases with 19 bone broken points,the positions are at dens ,side plank of atlas,occipital,plank of axis,processus spinosus etc.23 cases with axis and atlas half dislocation.of which,16 cases were with pure dislocation,7 cases with rotating dislocation,11 cases were with swollen at the side of vertebra,2 cases with depressing of vertebral artery,5 cases with continued narrowing of vertebral canal.conclusions: ct has the advantage of quickness,safety and high density discerning,it can reveal details of acute axis and atlas damages,so it has great importance to treatment scheme making and to the prognosticate.

结果：13例共见19处骨折，部位分别为齿状突、寰椎侧块、枕骨、枢椎椎板、棘突等，寰枢关节脱位23例，其中单纯性脱位16例，旋转性半脱位7例，11例合并椎旁血肿，2例见椎动脉受压，5例继发性椎管狭窄。结论：ct具有快捷、安全、密度分辨率高等优点，可明确急性寰枢关节损伤细节，对制定治疗方案及估价预后具有重要作用。

The peak of the bulge accorded with the vertical line through the posterior convexity of superior articular surface of atlas. The superimpose rate of the vertical line with the M line were 48% to left and 65% to right. The surplus existed in l～2mm to lateral of M line. The exit point of screw was the median point of vertical line on the anterior cortex of lateral mass. The superimpose rate of BB line the line linked with the

寰椎后结节中点及上关节突后凸尖下的骨质弧形隆起的顶点可作为寰椎椎弓根螺钉进钉点的准确标志，上关节突后凸尖及横突尖可作为寰椎椎弓根进钉点的大体标志；沿寰椎椎弓根轴线进钉较为安全，内倾17°，仰角变异大，出钉参照前结节顶点；椎动脉沟中外的厚度及进钉点处寰椎后弓的高度是寰椎椎弓根螺钉固定的主要限制性因素。

In response to repetitive strain and inflammation, the synovial l-z joints can fill with fluid and distend, resulting in pain from stretching the joint capsule.71 Distension of the articular recesses can also compress the exiting nerve root in the neural foramen or spinal canal, especially when the foramen is already narrowed by joint hypertrophy and/or osteophytes.

反复的应力与炎症反应，可使滑膜l-z关节充满滑液并扩张，导致关节囊收到牵拉产生疼痛。关节囊隐窝的扩张可以压迫神经孔出的神经根出口或压迫椎管内脊髓，尤其当由于关节肥大和/或骨赘形成已经存在椎间孔狭窄时发生率更高。

Cases with bone graft fusion were Resected lateral part of lesion vertebral lamina and process;2 cases were treated with contralateral interanticular process and vertebral lamina bone graft fusion; 2 cases with intravertebral fusion were treated by laminectomy and arthrectomy of one side by posterior route and USS implantating; Others cases were routine internal fixation.

行植骨融合术2 例，切除患侧椎板外半和椎间相应关节突；行对侧椎板关节突间植骨融合2例，行后路半椎板和一侧小关节切除USS 植入，椎间融合2例，余采用常规手术内固定。

First 27 rabbits of the experimental group were destabilizated by operated on L6、7.Inj Diazepam 0.25 mg/kg,Inj Ketamine 0.02 g/kg and Inj Atropine 0.125 mg/kg was one by one injected into the rabbit through the auris vein,shearing the rabbit hair of backside waist,fixing the rabbit on operation table in face lying,using 1% Povidone Ioding to degerm the operation area.Every rabbit was incised at the backside of its waist,that incisal opening is located in the center of the intervertebral space (L6、7 space) that both side iliac crest line correspond ,from the meso-ordinate direction cut about 4 cm incision,cutting open skin and subcutaneous tissue,thoroughly ,exposing the spinous processes the vertebral plates and the upper-inferior articular processes,entirely segregating the muscles that cohere the spinous processes the vertebral plates and the articluar process,then excising the supraspinal ligaments and interspinal ligaments,biting off two sides the inferior articular processes of L6,in order that resulting in intervertebral destabilization,using 0.9% Inj.Sodium Chloride to washout the incisal opening,in order sewing up each layer tissues.

方法］ 取48只6个月龄日本大耳白兔，雌雄不限，体重为（2.5±0.2） kg，随机进行分组，分为对照组和实验组，对照组为21只；实验组为27只；先将实验组兔腰背部皮毛剪除，用安定注射液1.25 mg/kg、氯胺酮0.02 g/kg、阿托品0.125 mg/kg顺次耳缘静脉注射麻醉后，俯卧固定于手术台上，用1%碘伏消毒手术区域，以髂嵴平对椎间隙（即L6、7）为中心，从正中取一长约4 cm纵行切口，切开皮肤及皮下组织，锐性分离，暴露棘突、椎板及上下关节突，将附着于棘突、椎板及小关节的肌肉全部分离开，然后依次切除L6、7棘上及棘间韧带，咬除第6腰椎两侧下关节突，造成椎间失稳，用无菌生理盐水冲洗切口，依次缝合各层组织；术后动物在笼中自由活动。

Inj Diazepam 0.25 mg/kg,Inj Ketamine 0.02 g/kg and Inj Atropine 0.125 mg/kg was one by one injected into the rabbit through the auris vein,shearing the rabbit hair of backside waist,fixing the rabbit on operation table in face lying,using 1% Povidone Ioding to degerm the operation area.Every rabbit was incised at the backside of its waist,that incisal opening is located in the center of the intervertebral space (L6、7 space) that both side iliac crest line correspond ,from the meso-ordinate direction cut about 4 cm incision,cutting open skin and subcutaneous tissue,thoroughly ,exposing the spinous processes the vertebral plates and the upper-inferior articular processes,entirely segregating the muscles that cohere the spinous processes the vertebral plates and the articluar process,then excising the supraspinal ligaments and interspinal ligaments,biting off two sides the inferior articular processes of L6,in order that resulting in intervertebral destabilization,using 0.9% Inj.Sodium Chloride to washout the incisal opening,in order sewing up each layer tissues.

方法］ 取48只6个月龄日本大耳白兔，雌雄不限，体重为（2.5±0.2） kg，随机进行分组，分为对照组和实验组，对照组为21只；实验组为27只；先将实验组兔腰背部皮毛剪除，用安定注射液1.25 mg/kg、氯胺酮0.02 g/kg、阿托品0.125 mg/kg顺次耳缘静脉注射####后，俯卧固定于手术台上，用1%碘伏消毒手术区域，以髂嵴平对椎间隙（即L6、7）为中心，从正中取一长约4 cm纵行切口，切开皮肤及皮下组织，锐性分离，暴露棘突、椎板及上下关节突，将附着于棘突、椎板及小关节的肌肉全部分离开，然后依次切除L6、7棘上及棘间韧带，咬除第6腰椎两侧下关节突，造成椎间失稳，用无菌生理盐水冲洗切口，依次缝合各层组织；术后动物在笼中自由活动。

［Objective］ To analyze the outcome of internal fixation for occipitalization with atlantoaxial joint dislocation by posterior decompression and occipitocervical fusion ［Method］ From December 2005 to June 2007,8 patients with occipitalization and atlantoaxial joint dislocation received removal of the posterior arcus of atlas and the enlargement of the posterior edge of the foramen magnum after skull traction performing for an average of 135 daysAll patients were operated on by posterior craniocervical fusion using cervifix internal fixation system and autologous ilium graftsThe clinical efficacy after operation was analyzed by Japanese Orthopaedic Associationneural function score ［Result］ All the patients were followed up from 6 months to 2 years, average of 15 monthsNo complication was foundAtlantodental interval was 5~9 mm before and 4~6 mm after skull tractionAtlantoaxial joint dislocation didn't completely reducedThe neurological defects were improved to some extents according to the JOA scoreImageology showed all patients had full decompression and bony fusionThe loosening or broken internal fixation was not found ［Conclusion］ Posterior decompression and fusion is a feasible method for the treatment of occipitalization with atlantoaxial joint dislocation,and the clinical effect is satisfactory

分析后路减压枕颈融合内固定术治疗合并寰枢关节脱位的寰椎枕骨化临床疗效。［方法］2005年12月至2007年6月间，对8例合并寰枢关节脱位的寰椎枕骨化患者在行颅骨牵引治疗一段时间（12~16 d，平均135 d）后采用枕骨大孔后缘扩大，寰椎后弓切除减压取自体髂骨枕颈融合Cervifix系统内固定术，手术后采用日本骨科学会神经功能评分分析临床疗效。［结果］8例患者随访6个月~2年，平均为15个月。8例患者无一例出现术后并发症，术前寰齿前间隙为5~9 mm，经颅骨牵引后为5~7 mm，寰枢关节脱位未能完全复位。手术前后JOA评分示神经症状均有不同程度恢复，影像学检查示枕颈区减压充分植骨区获得骨性融合，无一例出现内固定松动或断裂。［结论］合并寰枢关节脱位的寰椎枕骨化患者术前仔细评估影像学改变，采用颅骨牵引一段时间后行后路减压枕颈融合内固定术的治疗方案是合理可行的，且临床效果满意。

This series included 35 male and 22 female, and the mean age was 34.6 years (range, 13– 66 years). The pathology included atlantoaxial instability in 52 patients (os odontoideum in 26 patients, transerse ligament relaxation or disruption in 20, odontoid fracture nonunion in 6), and irreducible atlantoaxial dislocation in 5 (os odontoideum in 1 patient, transerse ligament relaxation in 1, malunion of odontoid process fracture in 3). Twenty-four patients presented signs and symptoms of spinal cord and/or brain-stem dysfunction.

这个系列包括35个男性病人和22个女性病人，平均年龄是34.6岁（范围，13~66岁）。52个病人是寰枢椎不稳（26例os odontoideum、20个横韧带松弛或破裂、6例齿状突骨折不连），5例不可复位的寰枢椎关节脱位（1例os odontoideum，1例横韧带松弛，3例齿状突骨折连接不正）。24例有脊索和脑干功能不良的症状和体征。

Breath, muscle contraction of the buttocks; arch body, as far as possible to hold his head, right leg straight towards the ceiling (peg-leg knee in order to avoid muscle tension).

呼气，收缩臀部肌肉；拱起身体，尽量抬起头来，右腿伸直朝向天花板（膝微屈，以避免肌肉紧张）。

The cost of moving grain food products was unchanged from May, but year over year are up 8%.

粮食产品的运输费用与5月份相比没有变化，但却比去年同期高8％。