中上颈椎侧块与寰椎椎弓根位置关系的解剖研究

目的研究中上颈椎侧块与寰椎椎弓根的位置关系,建立以中上颈椎侧块为解剖标志的寰椎椎弓根螺钉进钉点定位技术。方法20具尸体标本,分别测量寰椎椎弓根和中上颈椎侧块的内缘、中点、外缘与正中矢状面的垂直距离,通过分析测量值间的关系,建立寰椎椎弓根螺钉进钉定位技术。结果C2-4侧块的内缘分别在寰椎椎弓根内缘外侧0．37mm、0．27mm、0．24mm处;C2-4侧块的中点分别在寰椎椎弓根中点外侧1．18mm、1．41mm、1．74mm处;C2-4侧块的外缘分别在寰椎椎弓根外缘外侧1．96mm、2．54mm、3．24mm处。结论中上颈椎侧块与寰椎椎弓根间存在较恒定的解剖位置关系,C3和C4侧块与枢椎侧块一样,可作为术中确定寰椎后弓显露范围和判断寰椎椎弓根螺钉进钉点的解剖学标志。     

枢椎椎弓根螺钉进钉点的解剖定位研究

目的研究枢椎下关节突与枢椎椎弓根的位置关系,建立以枢椎下关节突为解剖标志的枢椎椎弓根螺钉进钉定位技术。方法取50套成人干燥枢椎标本,测量枢椎椎弓根的内、外缘和枢椎下关节突的内缘、中点、外缘分别与正中矢状线的垂直距离,以及枢椎椎弓根的宽度与高度。通过分析测量值间的关系,建立枢椎椎弓根螺钉的进钉定位技术。结果枢椎下关节突内缘在枢椎椎弓根内缘的外侧(3.67±0.41)mm处,枢椎下关节突中点在枢椎椎弓根外缘的外侧(1.15±0.44)mm处。建立了两种以枢椎下关节突为标志的进钉点定位方法,进钉点A位于枢椎下关节突内上象限,即中心点内、上各2mm处;进钉点B位于经枢椎下关节突内缘的纵垂线与枢椎下关节突中上1/4水平线的交点。结论枢椎下关节突与枢椎椎弓根间存在较恒定的解剖位置关系,枢椎下关节突可作为术中判断枢椎椎弓根位置和确定枢椎椎弓根螺钉进钉点的简易解剖学标志。     

后路寰椎侧块螺钉结合枢椎椎弓根螺钉固定治疗寰枢椎不稳

目的探讨应用寰椎侧块螺钉与枢椎椎弓根螺钉固定融合治疗寰枢椎不稳的疗效。方法2002年2月至2004年3月,采用寰椎侧块螺钉结合枢椎椎弓根螺钉技术治疗寰枢椎不稳15例,男9例,女6例;年龄15～57岁,平均39.5岁;齿突陈旧性骨折5例,先天性游离齿突4例,新鲜齿突骨折6例(AdersonⅡC型)。所有患者均伴有寰枢椎半脱位或不稳,表现为不同程度的颈枕区疼痛,活动受限。术前JOA评分5.1￣10.9分,平均7.6分。术前行颅骨牵引。寰椎侧块螺钉进钉点选择在寰椎后结节中点旁18￣20mm与后弓下缘以上2mm的交点处,钉道与冠状面垂直,矢状面上螺钉头端向头侧倾斜约5°。枢椎椎弓根螺钉进钉点为枢椎下关节突根部中点,钉道与矢状面夹角约15°,与横断面夹角约30°。螺钉直径3.5mm,寰椎侧块螺钉长28～32mm,枢椎椎弓根螺钉长22～26mm。应用Vertex7例,Axis3例,Cervifix5例。结果15例患者共置入寰椎侧块螺钉和枢椎椎弓根螺钉各30枚。术后无一例患者发生脊髓和椎动脉损伤。所有患者均获随访,随访时间10～25个月,平均14个月。术后6个月JOA评分13.2～16.8分,平均14.8分,改善率为87.5%。骨折的齿突均骨性愈合,植骨块全部融合,无内固定断裂、松动。结论后路寰椎侧块螺钉结合枢椎椎弓根螺钉固定具有稳定的三维固定效果,可用于治疗寰枢椎不稳。     

后路寰椎侧块螺钉结合枢椎椎弓根螺钉固定治疗上颈椎不稳

目的：总结应用寰椎侧块螺钉与枢椎椎弓根螺钉技术固定融合治疗寰枢椎不稳的效果，探讨寰枢椎不稳的治疗方法。方法：采用寰椎侧块螺钉与枢椎椎弓根螺钉技术对15例寰枢椎不稳的患者进行了固定术，同时行自体髂骨融合。分别应用Vertex 7例，Axis 3例，和cervifix 5例，齿状突陈旧性骨折5例，新鲜Ⅱc型齿状突骨折6例，先天性游离齿状突4例。寰椎侧块螺钉进钉点选择在寰椎后结节中点旁开18mm～20mm，与后弓下缘以上2mm的交点，钉道方向在冠状面垂直，矢状面上螺钉头端向头侧倾斜约5°.枢椎进钉点为枢椎下关节突根部中点，钉道与矢状面夹角约15°，横断面夹角约30°。螺钉直径3．5mm，寰椎侧块螺钉长度28mm～32mm，枢椎椎弓根螺钉长度为22mm～26mm。结果：所有患者均未发生脊髓损伤和椎动脉损伤。随访10～25个月，平均14个月。术前JOA评分5．1～10．9分，平均7．6分。术后JOA评分13．2～16．8分，平均14．8分，改善率87．5％。植骨块全部融合，无内固定断裂、松动。结论：后路寰椎侧块螺钉与枢椎椎弓根螺钉技术稳定性良好，具有三维固定的优点，值得推广。     

多轴向钉棒系统经寰椎侧块枢椎椎弓根 螺钉固定治疗寰枢椎不稳

[目的]探讨应用多轴向钉棒系统经寰椎侧块枢椎椎弓根螺钉固定治疗寰枢椎不稳的方法及疗效.[方法]应用多轴向钉棒系统治疗寰枢椎不稳12例,术前JOA评分平均7.6分;寰椎使用侧块螺钉,进钉点选择在寰椎后结节中点旁18～20 mm与后弓下缘以上2 mm的交点处,钉道方向与冠状面垂直,矢状面上螺钉头端向头侧倾斜约5°;枢椎下关节突根部中点为进钉点,钉道与矢状面夹角约15°,与横断面夹角约25°.[结果]术后无1例发生椎动脉及脊髓损伤,JOA评分平均15.1分,改善率平均为87.3%.[结论]多轴向钉棒系统治疗寰枢椎不稳复位简单,具有稳定的三维固定效果,安全可靠.     

寰椎椎弓根螺钉进钉点的解剖定位研究

目的 建立简易可靠的寰椎后路椎弓根螺钉进钉点的定位技术。方法 设定寰椎椎弓根螺钉的进钉点,利用40套干燥配套寰枢椎标本,测量与进钉点相关的数据参数,分析数据之间的关系。结果 寰椎椎弓根螺钉进钉点和枢椎下关节突中线与后正中矢状面的距离分别是19.61mm、19.21mm,二者仅相差0.40mm。结论 枢椎下关节突中心点可作为术中判断寰椎椎弓根螺钉进钉点的解剖学定位标志。     

枢椎椎弓峡部引导下寰椎椎弓根置钉的CT测量及其应用

目的:探讨在枢椎椎弓峡部引导下实施寰椎椎弓根螺钉置钉的可行性及安全性。方法:对48例成人寰枢椎行三维CT重建,取枢椎椎弓峡部内上缘与寰椎的横断面图像。测量椎管正中线至寰椎椎弓根内壁、外壁及枢椎椎弓峡部内壁、外壁的距离,分别为L1、D1、L2、D2;0°内倾角置钉时,以枢椎椎弓峡部内上壁为解剖标志,确立最内侧进钉点A和最外侧进钉点B,减去螺钉半径1.75mm,A、B点至枢椎椎弓峡部内上壁的距离分别为(L1-L2+1.75mm)、(D1-L2-1.75mm),寰椎后弓上置钉时螺钉允许的最大内倾角与最大外倾角大致相等时的点为最佳进钉点(M点),记录M点至枢椎椎弓峡部内上壁水平间距。自2004年3月～2009年3月对29例患者采用以枢椎椎弓峡部为标志实施后路寰枢椎椎弓根螺钉内固定手术,其中陈旧性齿状突骨折24例,横韧带损伤并寰椎前脱位5例。观察手术过程中与寰椎椎弓根螺钉置钉相关的并发症,术后三维CT重建观察螺钉的位置。结果:0°内倾角置钉时,CT测量最内侧进钉点A、最外侧进钉点B、最佳进钉点M至枢椎椎弓根峡部内上壁的水平间距分别为4.22±0.54mm、8.66±0.73mm、5.79±0.63mm。临床共置入寰椎椎弓根螺钉58枚,术中枢椎椎弓峡部内上壁均得到良好显露,未出现椎动脉、静脉丛损伤出血及脊髓、C2神经根损伤等并发症。术后三维CT复查显示所有寰椎椎弓根螺钉均未误入椎管或椎动脉孔,测量寰椎椎弓根螺钉进钉点与枢椎椎弓峡部内上壁水平间距为5.45±0.82mm,与术前M点测量值相比较无显著性差异。结论:在纠正寰椎旋转移位后,以枢椎椎弓峡部内上壁作为解剖参照,寰椎椎弓根存在一定的置钉安全区间,利用该解剖标志行寰椎椎弓根置钉是安全可行的。     

寰椎椎弓根螺钉置钉的解剖与临床研究

目的：建立和验证寰椎后路椎弓根螺钉固定的进钉技术。方法：利用40套干燥配套寰枢椎标本测量进钉技术的相关参数，而后临床应用该技术方法置钉并行X线、CT复查其准确性。结果：寰椎椎弓根平均宽度为7．78mm，进钉点在寰椎椎弓根中线外侧2．2m，螺钉进钉点可由经枢椎下关节突中点的纵垂线来确定；手术中该方法不仅能简化操作过程，而且术后检查发现螺钉均准确置入。结论：用枢椎下关节突中点作为术中判定寰椎椎弓根螺钉进钉点的方法准确可靠。     

寰椎椎弓根螺钉进钉点的解剖定位研究

目的：建立简易可靠的寰椎后路椎弓根螺钉进钉点的定位技术。方法：设定寰椎椎弓根螺钉的进钉点，利用40套干燥配套寰枢椎标本，测量与进钉点相关的数据参数，分析数据之间的关系。结果：寰椎椎弓根螺钉进钉点和枢椎下关节突中线与后正中矢状面的距离分别是19.61mm、19．21mm，二者仅相差0．40mm。结论：枢椎下关节突中心点可作为术中判断寰椎椎弓根螺钉进钉点的解剖学定位标志。     

枢椎椎板螺钉联合寰椎椎弓根螺钉固定治疗寰枢椎脱位

目的 评价枢椎椎板螺钉联合寰椎椎弓根螺钉固定融合治疗寰枢椎脱位的临床可行性.方法 对5例枢椎椎弓根细小的寰枢椎脱位患者,在气管插管全身麻醉下施行了枢椎椎板螺钉联合寰椎椎弓根螺钉固定术.枢椎椎板螺钉的进钉点位于棘突两侧椎板交界处,交叉置人对侧椎板内;寰椎椎弓根螺钉的进钉点位于枢椎侧块中线上,距寰椎后弓上缘最少3 mm,内斜10°,上斜5°.螺钉直径3.5 mm,枢椎椎板螺钉长26～32 mm,寰椎椎弓根螺钉长28～32 mm,结合自体髂骨植骨.结果 患者获得随访3～18个月,平均7.5个月.未发生椎动脉、脊髓损伤,术后临床症状得到不同程度的改善,X线、CT复查螺钉位置良好,无松动、断钉,植骨3个月后均达到满意融合.结论 枢椎椎板螺钉联合寰椎椎弓根螺钉固定治疗寰枢椎脱位效果满意,是又一可供选择的寰枢椎后路固定术式.     

Fractures of the C1 and C2 Vertebrae

Upper cervical fractures of the axis and atlas (C1 and C2, respectively) typically occur in children and in the elderly population. The anatomic characteristics of the craniocervical junction allows for unique fracture patterns. Jefferson fractures of the atlas are the classic fracture presentation of the C1 vertebrae. Odontoid fractures and traumatic spondylolisthesis of the axis are the most commonly reported fractures of the C2 vertebrae. This chapter will review the anatomy, injury mechanisms, and fracture types seen in the C1 and C2 vertebrae. In addition, several nonoperative and operative treatment options, supported by the literature, will be discussed.     

Surgical stabilization of C1 and C2 fractures

We present operative procedures for the stabilization of fractures of C1 and C2. As is the case for fractures of the extremities, a direct approach to the injury should be attempted in order to avoid the inclusion of intact segments in the spondylodesis. The aim of the three presented techniques - direct screw fixation of fracture of the dens axis and traumatic lysis of C2 - is to active anatomical reconstruction by optimal stabilization. The new technique of transarticular screw fixation of C1-2 developed by Magerl allows unisegmental three-dimensional stabilization in cases in which at least a three-level fusion would have previously been considered necessary.     

磷脂酶C与生殖

磷脂酶C(PLC)是磷脂酰肌醇信号转导途径中一个关键酶。目前确认的哺乳类PLC共有PLC β、PLC γ、PLC δ、PLC ε和最近新发现的PLC ζ 5种亚型 ,12种同工酶。不同亚型的结构、调控和组织分布各有差异。PLC在调控信号转导通路中的特性使其在顶体反应、卵子激活中发挥了巨大的作用。本文综述了PLC家族 5种亚型的结构、调控机制及PLC在男性生殖领域的相关内容 ,包括PLC引起卵子发生Ca2 + 振荡、激活卵子、促进胚胎发育等 ,并进一步探讨了PLC在临床上可能的应用前景。     

Hepatitis C and glomerulonephritis

Summary: Several systemic viral infections have been associated with the development of glomerular lesions. of the viruses that cause liver disease hepatitis B was the first to be recognized. the recent availability of serologic tests for the hepatitis C virus (HCV) has uncovered an association between HCV infection and renal disease. the principal glomerular lesion that develops is that of a membranoproliferative glomerulonephritis (MPGN), usually in association with antigenaemia and circulating immune complexes that have the characteristics of mixed cryoglobulinaemia represented by polyclonal IgG and monoclonal IgM with rheumatoid factor activity. the presence of a very high percentage of anti-HCV seropositivity in cryoglobulinaemic forms of MPGN suggests that the virus plays an important role in the pathogenesis of the associated immune complex glomerulonephritis. Precipitates containing HCV-RNA and circulating anti-HCV IgG and IgM have been found in the majority of such cases. the course of the renal disease that develops is progressive. Treatment with interferon alpha appears to attenuate the progression of the renal lesions, and the response to treatment appears to be closely related to the clearance of hepatitis C viraemia. Renal lesions also occur in the absence of clinical evidence of liver disease or mixed cryoglobulinaemia. In addition to MPGN, membranous glomerulonephropathy, IgA nephropathy and focal segmental glomerulosclerosis have been reported in these cases of HCV infection. the prevalence of glomerular lesions in patients with HCV infection remains to be determined. the available serologic tests for HCV are still in evolution. In the meantime, all patients presenting with glomerular disease should be screened for HCV.     

Thyroid and hepatitis C

Autoimmune thyroid diseases are complex diseases that develop as a result of interactions between genetic, epigenetic and environmental factors. IFNa therapy of chronic HCV infection is associated with subclinical or clinical thyroiditis, while the relationship between thyroiditis and virus C infection is still debated.     

Uptake kinetics of14C L-leucine and14C L- and14C D-methionine in rat brain and incorporation into protein

Because the amino acids¹¹C L-leucine,¹¹C L-methionine, and¹¹C D-methionine are used for examinations of brain tumors with positron emission tomography (PET), the uptake of the corresponding¹⁴C substances and their incorporation into protein was studied in the rat brain. The uptake of all three substances from the plasma, across the bloodbrain barrier, and into the brain took place quite quickly; return to the plasma seemed negligible. Incorporation into protein took place much more slowly.     

Mesangiocapillary glomerulonephritis associated with meningococcal meningitis,C3 nephritis factor and persistently low complement C3 and C5

We report two unusual cases in which mesangiocapillary glomerulonephritis occurred in association with meningococcal infection. C3 nephritic factor, an autoantibody to alternate pathway C3 convertase, was present. Low serum complement C3 and C5 levels were also noted. The depressed complement levels, in conjuction with terminal complement complexes at the upper limit of normal, suggest activation of the early and late complement cascade. We suggest that children presenting with meningococcal infection should have a regular urine examination, as well as full complement measurements performed, in view of the association with hypocomplementaemic mesangiocapillary glomerulonephritis. Similarly, prophylactic penicillin should be prescribed for patients with mesangiocapillary glomerulonephritis and persistently low C5 levels to prevent meningococcal complications.