椎关节

Methods. A 60-year-old man with athetoid cerebral palsy and a history of posterior occipitocerical fusion presented with quadriparesis. Salage surgery for cerical myelopathy and pseudarthrosis was performed with laminectomy and rearthrodesis using the pedicle screw system. An intraspinal cyst was identified as the main cause of the paraparesis.

一位60岁的手足徐动症样大脑麻痹患者，既往曾行后路枕颈融合术，临床表现为四肢轻瘫，影像学检查示脊髓型颈椎病和假关节形成，采用椎板切除和椎弓根钉系统关节成形术后，发现椎管内存在的囊肿是导致四肢轻瘫的主要原因。

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.

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。

Results In 7 cases of odontoid process fracture, X-ray demonstrated 4 cases and CT demonstrated 5 cases, whereas the spiral CT reconstruction diagnosed 7 cases, which could display the displacement of fracture clearly. The X-ray and CT showed asymmetric space between left and right gaps of atlantoaxial joint in 6 cases, while spiral CT reconstruction showed normal and excluded the possibility of atlantoaxial dislocation. There was one case of lateral atlantoaxial joint dislocation, which was demonstrated by the spiral CT reconstruction clearly but not by the X-ray and CT scan. There were 3 cases of atlantoaxial congenital deformity (1 case of absence of both posterior arch of atlas and odontoid process and 2 cases of maldevelopment of the odontoid process), which were displayed clearly by spiral CT reconstruction, but misdiagnosed as odontoid process fracture and atlantoaxial subluxation by X-ray and CT scan.

结果 7例齿状突骨折中，X线显示4例，CT显示5例，CT重建确诊7例，且清楚显示骨折移位情况；6例X线、CT显示寰枢椎左右间隙不对称，通过CT重建排除寰枢关节半脱位；寰枢外侧关节脱位1例，CT重建可清楚显示，而X线片和CT平扫均未能显示；寰枢椎畸形3例，分别为齿状突、后弓缺如1例，齿状突发育不良2例，CT重建均能清楚显示，而X线、CT均误诊为齿状突骨折、寰枢椎半脱位。

Six cadavers were prepared for necroscopy, operative procedure of ILIF were simulated on L3-S1, and all related important anatomic structure and their relationship were observed and record. ILIF with transpedicle screw fixation were also performed with cage insertion.3. Twelve fresh frozen bovine lumbar functional spinal units were prepared for biomechanical testing. According to the different treatment order, the specimens were devided into 7 groups, which included: 1intact specimens, 2specimens were treated by left unilateral facetectomy and had homolateral anatomical threaded cages inserted, 3 TLIF with homolateral pedicle screw fixation, 4 TLIF with bilateral pedicle screw fixation, 5 specimens had anatomical threaded cages inserted on the left by intertransverse process approach, 6 ILIF with homolateral pedicle screw fixation, 7 ILIF with bilateral pedicle screw fixation.

方法1、对20名正常志愿者L3-S1节段进行CT增强+三维重建检查，在三维重建图形上测量横突长度、上下横突间距、椎间孔外椎间隙高度及斜径，观查横突间区域血管走形特点并测量血管内径，然后进行统计分析及评价。2、采用福尔马林固定尸体标本六具，模拟ILIF手术对L3-S1节段进行操作，观察横突间区域重要结构的位置和毗邻关系，并模拟同侧椎弓根钉和单枚椎间融合器的置入过程，探讨该术式存在的问题并改进。3、采用小牛脊柱运动节段标本12具，依序进行不同处理后分为以下7组：⑴正常对照组CG⑵左侧小关节切除+椎间融合器植入组(TLIF⑶TLIF附加同侧椎弓根钉固定组；⑷TLIF附加双侧椎弓根钉固定组；⑸左侧横突间入路椎间融合器植入组ILIF⑹ILIF附加同侧椎弓根钉固定组；⑺ILIF附加双侧椎弓根钉固定组。

Macroscopically, each facet joint is composed of a posteromedially facing concave superior articularprocess from the inferior vertebral body, and as maller anterolaterally facing inferior articular processfrom the superior spinal level.

大体观，每个小关节由下位椎体朝向后内侧凹陷的上关节突以及上位椎体朝向前外侧的的下关节突组成。

Macroscopically, each facet joint is composed of a posteromedially facing concave superior articularprocess from the inferior vertebral body, and as maller anterolaterally facing inferior articular processfrom the superior spinal level.

大体观，每个小关节由下位椎体朝向后内侧凹陷的上关节突以及上位椎体朝向前外侧的的下关节突组成。L-z关节的形状及朝向决定了其作用为阻止脊柱过度运动。

According to the first, intravertebral vacuum phenomenon is the result of vertebral osteonecrosis,8,14,17,18 whereas the second theory supports that intravertebral vacuum phenomenon signifies nonunion and pseudarthrosis of a vertebral fracture.20,21 A third theory, which did not find appeal, suggested that intravertebral gas could be of intradiskal origin, leaking to the vertebra through the fracture, since a high coincidence (86%) of intervertebral disk vacuum was noted in cases of intravertebral vacuum.6

第一种理论认为椎体内真空现象是椎体缺血性坏死的结果[8，14，17，18]，而第二个理论认为椎体内真空现象意为着骨不连和假关节[20，21]，另外目前还未广泛接受的第三个理论认为椎体内气体可能是从椎间盘中从椎体骨折裂隙中流入的，椎体内出现真空现象的同时伴有椎间盘内真空的比例很高（86％）[6]。

objective to investigate the effect of radiography and method of operation on the surgical indication as well as the operation treatment of lumbar disc herniation and lumbar canal stenosis.methods the data of 300 cases with lumbar disc herniation and lumbar canal stenosis were reviewed from jan 1999 to dec 2004.all cases were treated by the method of minimal invasive open operation.the nucleus was resected through an 3.5～4.5cm in length.the sacrospinalis muscle between laminae was stripped partly and the part of upper lamina and the part of medial facet was resected.

目的 探讨影像学检查和手术方法对腰椎间盘突出症和椎管狭窄症手术方式和适应证的影响。方法自1999年1月～2004年12月，为300例腰椎间盘突出症和椎管狭窄症患者实施微创开放式手术，做3.5～4.5cm长的皮肤切口，剥离椎间的部分骶棘肌，咬除部分椎板上缘及小关节内侧缘后，摘除髓核，并根据需要做半椎板或全椎板手术或扩大神经根管和切除肥厚的黄韧带及神经管内的骨性增生。

Methods:keep supraspinous ligament,interspinous ligament ,thoracolumbar and the periosteum of lamina.The supraspinous ligament and interspinous ligament was cut off below affected spinal canal.The lamina was cut off longitudinally with a chisel along the outside of lamina,detach ligament flavum bilaterally,and reverse upward lamina and the compound structure of back to open spinal canal.

将部分腰背筋膜、棘上韧带、棘间韧带及椎板上骨膜保留，于病变节段下一椎间隙切断棘上棘间韧带，用骨刀（骨刀宽面与矢状面成角10~15度）在上下关节内侧2mm处自下而上并保持骨刀宽面进入椎板深度与椎板厚度相一致切断两侧椎板，牵开椎板及棘上棘间韧带，常规进行椎管减压，椎板及棘上棘间韧带回植。

The displacement of the left articular facet was larger than that of the right articular facet,the same to the cervical foraminal area.The right-posterior-lateral disc protruded toward back-inner.

左侧小关节面相对位移较大，左侧椎间孔变大；右侧椎小关节面间移位小，右侧椎间孔变小，椎间盘右后外侧部向后突出。

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％。