为开阔临床医师视野，提供理论水平和借鉴临床经验，今后将陆续推出在读战友和临床感兴趣的战友利用业余时间创作的spine等杂志的中英文对照稿供大家参阅鉴赏。感谢无私奉献的战友！战友的成长离不开您辛勤的汗水向无私奉献的战友致敬！！期待更多的战友参与活动一、规则：1、 愿意参与翻译工作的战友，请以回帖形式申请具体翻译的部分 ，为避免重复翻译，以每个主题加予序号（1、2、3....）为单位的形式认领 a、（每位战友每月限领1－2个专题，以减轻工作量，也给其他战友积极参与的机会）b、重复翻译者（未跟贴认领，导致其他战友重复翻译）未跟贴者无积分奖励。c、已经认领的显示为 红色尚未认领的显示为 黑色认领翻译文献请到这里：>3、翻译小组成员：感兴趣言而有信者即可参与4、日常事物处理：shamo5、daihatsu、心愿、小骨头注：各组员如有特殊情况无法及时完成工作，请提前pm版主，以便作出相应安排。三、积分奖励机制：（试行）1、摘要一篇，奖励1分；全文一篇奖励3分2、校验工作，摘要每1贴次1分，全文每1贴次3分。2、The Efficiency of Gabapentin Therapy in Patients With Lumbar Spinal Stenosis加巴喷丁治疗腰椎管狭窄症的疗效观察Study Design. Randomized controlled study.研究设计：随机对照法Objectives. To investigate the efficacy of treatment with gabapentin on the clinical symptoms and findings in patients with lumbar spinal stenosis (LSS).目的：研究加巴喷丁治疗腰椎管狭窄症的有效性Summary of Background Data. LSS is a syndrome resulting from the narrowing of the lumbar nerve root canal, spinal canal, and intervertebral foramen, causing compression of the spinal cord. The most significant clinical symptom in patients with LSS is neurologic intermittent claudication (NIC). Gabapentin, which has been used in the treatment of neuropathic pain, may be effective in the treatment of symptoms associated with LSS.背景摘要：腰椎管狭窄症因腰椎神经根管、椎管、椎间孔狭窄，脊髓受压所引起，其最常见的症状为神经性间歇性跛行。加巴喷丁对神经性疼痛疗效确切，因此可能对腰椎管狭窄症症状缓解有效。Methods. Fifty-five patients with LSS, who had NIC as the primary complaint, were randomized into 2 groups. All patients were treated with therapeutic exercises, lumbosacral corset with steel bracing, and nonsteroidal anti-inflammatory drugs. The treatment group received gabapentin orally in addition to the standard treatment.方法：55例腰椎管狭窄症患者随机分为2组，所有患者均以神经性间歇性跛行作为主诉。两组患者均予以功能锻炼，以金属支具束腰，并口服非甾体类消炎药。治疗组在此基础上加服加巴喷丁。Results. Gabapentin treatment resulted in an increase in the walking distance better than what was obtained with standard treatment (P _ 0.001). Gabapentin-treated patients also showed improvements in pain scores (P _0.006) and recovery of sensory deficit (P _ 0.04), better than could be attained with the standard treatment.结果：加巴喷丁治疗组患者在增加步行距离方面优于基础治疗组，P＝0.001。在疼痛指数改善、感觉障碍恢复方面同样优于基础治疗组，P分别为0.006及0.04。Conclusion. Based on the results of our pilot study, extensive clinical studies are warranted to investigate the role of gabapentin in the management of symptomatic LSS.结论：根据初步研究结果，建议对加巴喷丁对腰椎管狭窄症治疗作用机制进行广泛的临床研究。Key words: lumbar spinal stenosis, gabapentin, neurogenic intermittent claudication.关键词：腰椎管狭窄症，加巴喷丁，神经性间歇性跛行8、Clinical Classification of Patients With Lumbar Spinal Stenosis Based on Their Leg Pain SyndromeIts Correlation With 2-Year Surgical Outcome基于下肢痛症状对腰椎管狭窄症患者的临床分型其与术后两年疗效的关系Study Design. Prospective follow-up and retrospective review of 174 patients surgically treated for degenerative lumbar spinal stenosis.研究设计：对174例经手术治疗的腰椎管狭窄症患者进行前瞻性随访及回顾性调查Objective. To examine whether the type of leg pain syndrome associated with lumbar spinal stenosis is correlated with outcome.目的：研究腰椎管狭窄症患者的下肢痛类型与手术疗效是否相关Summary of Background Data. Although classifying patients based on their leg pain syndrome is useful in planning surgical decompression, there is no validated method of classification and its prognostic significance remains unknown.背景摘要：尽管下肢痛类型有助于减压手术的设计，目前仍没有行之有效的分类方法，且其对于预后的意义仍然未知。Methods. Based on the type of leg pain, the patients were classified into 2 groups: unilateral and bilateral. Improvement in functional status was evaluated using the Quebec Back Pain Disability Scale; the symptoms were rated on a visual analog scale and the change from baseline to 2-year evaluation was noted. Associations between score changes and baseline variables were examined using multivariate analysis.方法：根据下肢痛类型，所有患者被分为2组：单侧疼痛组、双侧疼痛组。患者功能的改善采用魁北克背痛等级量表加以记录，临床症状则用VAS表记录，整个记录持续两年。两者之间的关系采用多变量分析检验。Results. The type of leg pain was independently associated with improvements in function and leg symptom scores but was not associated with improvement in the back pain score. After surgery, patients with unilateral leg pain had significantly greater improvements in function and leg symptoms than patients with bilateral leg pain.结果：下肢痛类型与功能改善及下肢症状缓解相关，但与背痛的缓解无关。在术后，表现为单侧下肢痛的患者在功能改善及下肢症状缓解方面明显优于双侧下肢痛者。Conclusion. In patients undergoing surgery for degenerative lumbar spinal stenosis, the preoperative type of leg pain predicts function and leg symptom outcomes.结论：在退变性腰椎管狭窄手术患者中，术前下肢痛的类型可以预测术后功能改善及下肢症状缓解的程度。Key words: lumbar spinal stenosis, lumbar radiculopathy, neurogenic claudication, surgical outcomes, function, pain, prognostic factors.关键词：腰椎管狭窄症，腰部神经根病，神经性跛行，手术疗效，功能，疼痛，预后因素Utility of Flexion-Extension Radiographs in Evaluating the Degenerative Cervical Spine. Cervical Spine Spine. 32(9):975-979, April 20, 2007.White, Andrew P. MD *; Biswas, Debdut BA +; Smart, Lawson R. MD ++; Haims, Andrew MD [S]; Grauer, Jonathan N. MD ++ Abstract: Study Design. Retrospective cohort of 258 consecutive patients.Objective. The purpose of this study is to determine the: (1) percentage of flexion-extension radiographs that revealed pathology not appreciated on neutral radiographs in the nontrauma population, and (2) frequency that these views led to a change in the management of these patients.Summary of Background Data. The utility of flexion-extension radiographs in the evaluation of the spine trauma or preoperative patient is well accepted, but the role of dynamic radiographs in the degenerative population is not well defined.Methods. Consecutive patients presenting with axial cervical, upper extremity radicular, or myelopathic symptoms underwent upright anteroposterior, neutral lateral, and flexion-extension lateral radiographs. Patients with recent trauma, rheumatoid arthritis, prior cervical fracture, prior cervical surgery, inadequate radiographs, or congenital anomalies were excluded. Three observers reviewed all radiographs after determining the best measurement method by a priori analysis of interobserver reliability.Results. Listhesis was observed on 23 of the neutral lateral images; 6 of these were found to have changes between flexion and extension (2-4 mm). Two patients (1%) had spondylolisthesis on flexion-extension radiographs not visualized on neutral lateral radiographs. A subsequent review of these patients' charts revealed no change in management based on these findings.Conclusions. Cervical flexion-extension radiographs are a method of assessing potential instability. In the degenerative population studied here, 1% had spondylolisthesis noted only on the flexion-extension images, and 3% had a change in spondylolisthesis. None of these, however, led to a changes in clinical management. These data, in conjunction with the extra cost and radiation exposure associated with additional views, led us to no longer regard dynamic radiographs as a useful part of the initial imaging for the patient with degenerative cervical conditions.[color=purple]颈椎动力位片在评估颈椎病的作用设计：回顾性连续分析258例颈椎病病人的颈椎动力位片。目的：本研究的目的是为了：（1）在非外伤性颈椎病人群中，普通正侧位X片上未显示，而在动力位片上发现有病变的人群比率。（2）以及根据这些片子临床处理的不同点。研究背景：利用颈椎动力位片来评估颈椎外伤不稳或术前判断已经广为应用，但其在普通颈椎病中的作用情况不清楚。研究方法：通过连续分析258例伴有轴性或上肢神经根症状或脊髓型颈椎病症状的颈椎病病人正位、侧位及动力位X片。排除伴有颈椎外伤、类风湿关节炎、先前有颈椎骨折和手术病史、拍片位置不理想及先天性畸形的病人。由3位观察者阅读所有X片，观察者间差异被排除。研究结果：在普通侧位片上共发现23例颈椎滑移不稳，其中6例在动力位片上有进一步变化（2－4mm）。有2例（1％）患者在动力位片上显示滑移，而在普通侧位片上未能发现。但是两者在临床处理方面无明显差异。结论：颈椎动力位片是发现颈椎潜在不稳的一种方法。在我们这组颈椎病人群中，仅在动力位片显示有滑移不稳的占1％，较侧位片有进一步发现有明显改变的占3％。但这些不同并没有导致临床处理方法的不同。这些数据结合患者的所用额外花费以及暴露的放射线照射表明颈椎动力位片不能再是颈椎病病人的一开始就应该接受的常规检查。[/color]An Unusual Case of Penetrating Injury to the Spine Resulting in Cauda Equina Syndrome: Case Presentation and a Review of the Literature. Case Report Spine. 32(9):E290-E293, April 20, 2007.Lee, Kendall H. MD, PhD *; Lin, Jessica S. MD *; Pallatroni, Henry F. MD +; Ball, Perry A. MD ++ Abstract: Study Design. Case study.Objective. We present an unusual case of cauda equina syndrome due to a penetrating injury in which the brake caliper of a motorcycle lodged in the lumbar canal of the operator of the vehicle after a road accident and provide a review of the literature on penetrating injury to the spine.Summary of Background Data. While the large majority of penetrating spinal injuries are due to gunshot wounds, penetrating injury to the spine causing cauda equina syndrome is rare.Methods. We report the case of a 42-year-old man involved in a motorcycle accident in which the brake caliper penetrated the lumbar region and entered the lumbar canal through the interlaminar space between L2 and L3. He had a complete motor and sensory deficit in the lower extremities with absent rectal tone. The patient was taken urgently to the operating room and underwent removal of the foreign object and repair of a dural laceration. He was treated with a course of intravenous antibiotics.Results. The wound healed without evidence for cerebrospinal fluid leakage or infection. The patient made a good neurologic recovery, becoming ambulatory with bowel and bladder continence at 5 months following the injury.Conclusions. Surgical removal of foreign object resulted in resolution of cauda equina syndrome injury.一例非一般的脊柱穿刺伤导致马尾综合症设计：病例报告。目的：我们报告一例由于摩托车驾驶者由于车祸致盘式制动器零件嵌入腰椎马尾部，导致马尾损伤，并综述相关脊柱穿刺伤的文献。背景：大多数脊柱穿刺伤都是由于枪伤引起，造成脊柱马尾损伤的非常少见。方法：患者，男，42岁，因骑摩托车撞伤，致盘式制动器戳伤滞留腰椎马尾，位于L2、3椎板之间。表现为两下肢感觉运动消失，鞍区感觉消失，肛门括约肌松弛。患者入院后，急诊手术，取出异物，修复撕裂的硬脊膜。术后予以静脉应用抗生素治疗。结果：患者未发生脑脊液漏和感染，术后5月随访，神经功能恢复良好，能够步行，大小便基本能够自我控制。结论：外科手术去除马尾部异物可以治愈外伤性马尾综合症。Total En Bloc Spondylectomy of C5 Vertebra for Chordoma. 颈5脊索瘤的全脊椎切除术Case Report 病例报告 Spine. 32(9):E294-E299, April 20, 2007 Currier, Bradford L. MD *; Papagelopoulos, Panayiotis J. MD +; Krauss, William E. MD ++; Unni, Krishnan K. MD [S]; Yaszemski, Michael J. MD, PhD * Abstract 摘要Study Design. En bloc resection of a chordoma of the C5 vertebra with wide surgical margins. 研究设计：采用广泛手术边缘对颈5脊索瘤行全脊椎切除Objective. To present the surgical technique of total spondylectomy for a chordoma of the C5 vertebral body. 目的：展示对颈5脊索瘤行全脊椎切除术的手术技巧Summary of Background Data. Malignant bone tumors require wide resection. Wide resection by total en bloc spondylectomy is difficult or not feasible for malignant vertebral tumors of the cervical spine due to the peculiar anatomic complexity of this region, including the vertebral arteries and the neural structures. There are no previous reports of en bloc resection of cervical spine tumors with wide surgical margins. 研究背景：恶性骨肿瘤需要广泛切除。广泛的全脊椎切除术对于颈椎恶性脊椎肿瘤是困难的或不能实现的，因为该区域解剖（包括椎动脉和神经组织）的复杂性。广泛手术边缘的颈椎全脊椎切除术尚未见报道。Methods. Using staged posterior and anterior approaches, a total en bloc spondylectomy and spine arthrodesis was performed. En bloc excision of a C5 chordoma was achieved using a threadwire T-saw (Tomita and Kawahara, Kanazawa, Japan) with surgical margins free of tumor. The patient received postoperative adjuvant proton beam radiation therapy. 方法：应用前后联合入路，行全脊椎切除和内固定。应用线丝T型锯实现颈5脊索瘤的无肿瘤边缘的全脊椎切除，术后辅助质子束放疗。Results. The patient remains disease-free 9 years after the operation. 结果：病人术后9年保持无病。Conclusion. Total en bloc spondylectomy with wide surgical margins is feasible for malignant bone tumors of the cervical spine.结论：广泛手术边缘的全脊椎切除术对于脊柱恶性肿瘤是可行的。10、Clinical Outcome of Symptomatic Unilateral Stress Injuries of the Lumbar Pars Interarticularis单侧应力性腰椎峡部损伤的临床治疗结果Study Design. A prospective case-series study.研究设计：前瞻性病例研究Objective. To evaluate the results of nonoperative and operative treatment of symptomatic unilateral lumbar pars stress injuries or spondylolysis.目的：评估非手术及手术治疗对于单侧应力性腰椎峡部损伤或椎体滑脱的疗效Summary of Background Data. Most patients become asymptomatic following nonoperative treatment for unilateral lumbar pars stress injuries or spondylolysis. Surgery, however, is indicated when symptoms persist beyond a reasonable time affecting the quality of life in young patients, particularly the athletic population.背景摘要：多数单侧应力性腰椎峡部损伤或椎体滑脱的患者接受非手术治疗后症状缓解。然而，在年轻患者，特别是运动员患者中，当症状持续一定时间以致于影响生活质量，这种情况下有手术指征。Methods. We treated 42 patients (31 male, 11 female) with unilateral lumbar pars stress injuries or spondylolysis. Thirty-two patients were actively involved in sports at various levels. Patients with a positive stress reaction on single photon emission computerized tomography imaging underwent a strict protocol of activity restriction, bracing, and physical therapy for 6 months. At the end of 6 months, patients who remained symptomatic underwent a computed tomography (CT) scan to confirm the persistence of a spondylolysis. Eight patients subsequently underwent a direct repair of the defect using the modified Buck’s Technique. Baseline Oswestry Disability Index (ODI) and Short-Form-36 (SF-36) scores were compared with 2-year ODI and SF-36 scores for all patients.方法：我们治疗了42例单侧应力性腰椎峡部损伤或椎体滑脱患者，其中31例为男性患者，11例为女性患者，2/3的患者曾积极参加各类体育活动。CT有阳性表现的患者接受为期6个月的严格治疗，包括限制活动、支具及理疗。6个月后，仍有症状的患者采用CT扫描，以确定是否存在持续的椎体滑脱。8例患者采用改良Buck技术直接修复损伤。所有患者评价治疗前及治疗后2年ODI指数和SF-36分数。Results. Eight of nine fast bowlers in cricket were right-handed. The spondylolytic defect appeared on the left side of their lumbar spine. In the nonoperated group, the mean pretreatment ODI was 36 (SD =10.5), improving to 6.2 (SD =8.2) at 2 years. In SF-36 scores, the mean score for physical component of health (PCS) improved from 30.7 (SD=3.2) to 53.5 (SD=6.5) (P <0.001), and the mean score for the mental component of health (MCS) improved from 39 (SD =4.1) and 56.5 (SD = 3.9) (P < 0.001) at 2 years. Twenty of 32 patients resumed their sporting career within 6 months of onset of treatment, and a further 4 of 32 patients returned to sports within 1 year. The 8 patients who remained symptomatic at 6 months underwent a unilateral modified Buck’s repair. The most common level of repair was L5 (n= 5). One patient with spina bifida and a right-sided L5 pars defect remained symptomatic following direct repair. The mean preoperative ODI was 39.4 (SD= 3.6), improving to 6.4 (SD =5.2) at the latest follow-up. The mean score of PCS (SF-36) improved from 29.6 (SD =4.4) to 49.2 (SD=6.2) (P <0.001), and the mean score of MCS (SF-36) improved from 38.7 (SD =1.9) to 54.5 (SD=6.4) (P< 0.001).结果：9名保龄球选手中的8位是右撇子，其椎体滑脱出现在椎体左侧。 非手术治疗组中，治疗前平均ODI指数为36（SD＝10.5），两年后改善为6.2（SD＝8.2）。SF-36分数中，PCS平均分在2年中从30.7（SD＝3.2）提高到53.5（SD＝6.5）(P <0.001)，MCS平均分则从39 (SD =4.1) 提高到 56.5 (SD = 3.9) (P < 0.001)。32例患者中的20例在开始治疗后6个月内重新参加体育活动，剩余的患者中有4例在1年内重返赛场。8例6个月症状无缓解的患者采用改良Buck技术修复单侧损伤。最常见的节段为L5（n＝5）。1例同时伴有脊柱裂及L5右侧峡部损伤的患者在术后症状仍未缓解。随访结束时，ODI指数从术前的39.4(SD =3.6)改善到6.4（SD＝5.2）。PCS平均分从29.6（SD＝4.4）提高到49.2（SD＝6.2）(P <0.001)，MCS平均分则从38.7 (SD =1.9) 提高到54.5 (SD = 6.4) (P < 0.001)。Conclusions. The increased incidence of the unilateral lumbar pars stress injuries or frank defect on the contralateral side in a throwing sports, e.g., cricket (fast bowling), may be related to the hand dominance of the individual. Nonoperative treatment for patients with a unilateral lumbar pars stress injuries or spondylolysis resulted in a high rate of success, with 81% (34/42) of patients avoiding surgery. If symptoms persist beyond a reasonable period, i.e., 6 months, and reverse gantry CT scan confirms a nonhealing defect of the pars interarticularis, one may consider a unilateral direct repair of the defect with good functional outcome. Direct repair in patients with spina bifida at the same lumbar level as the unilateral defect may be complicated by nonunion.结论：投掷类体育特别是保龄球选手中，单侧应力性腰椎峡部损伤或双侧直接损伤的发病率处于上升趋势，可能与个人的优势手有关。非手术治疗单侧应力性腰椎峡部损伤或椎体滑脱有很高的成功率，81％（32/42）的患者避免了手术。如果症状持续超过一定时间，特别是6个月以上，并且CT证实峡部不愈合时，通过手术修复单侧损伤效果良好。对同时伴有脊柱裂及同一节段峡部损伤的手术可能出现骨不连。Key words: spondylolysis, pars defect, pars interarticularis, unilateral pars defect. 关键词：椎体滑脱，峡部损伤，峡部，单侧峡部损伤 13、Quantitative Computed Tomography-Based Predictions of Vertebral Strength in Anterior Bending采用QCT测定椎体前屈强度Study Design. This study examined the ability of QCT-based structural assessment techniques to predict vertebral strength in anterior bending.研究设计：本研究旨在检测基于QCT的结构分析技术用于测定椎体前屈强度的能力Objective. The purpose of this study was to compare the abilities of QCT-based bone mineral density (BMD), mechanics of solids models (MOS), e.g., bending rigidity, and finite element analyses (FE) to predict the strength of isolated vertebral bodies under anterior bending boundary conditions.目的：本研究目的在于对基于QCT测定骨矿物质密度（BMD），建立力学实体模型（MOS），比如屈曲，及有限元分析（FE）在测定前屈条件下单个椎体强度的能力进行比较。Summary of Background Data. Although the relative performance of QCT-based structural measures is well established for uniform compression, the ability of these techniques to predict vertebral strength under nonuniform loading conditions has not yet been established. 研究背景：尽管基于QCT的结构分析技术在均衡压力条件下测量的相对能力确定，这些技术用于测定椎体不均衡负荷条件下强度的能力尚未明确。Methods. Thirty human thoracic vertebrae from 30 donors (T9–T10, 20 female, 10 male; 87± 5 years of age) were QCT scanned and destructively tested in anterior bending using an industrial robot arm. The QCT scans were processed to generate specimen-specific FE models as well as trabecular bone mineral density (tBMD), integral bone mineral density (iBMD), and MOS measures, such as axial and bending rigidities.方法：30例捐献者的30枚胸椎（T9-T10，20例男性，10例女性，年龄87±5岁）以QCT扫描，并以工业机械臂前屈椎体进行破坏性试验。QCT扫描用于形成样本FE模型、测定骨小梁矿物质密度（tBMD）及整体骨矿物质密度（iBMD）及采集MOS数据，如轴向、弯曲强度。Results. Vertebral strength in anterior bending was poorly to moderately predicted by QCT-based BMD and MOS measures (R2= 0.14–0.22). QCT-based FE models were better strength predictors (R2 = 0.34–0.40); however, their predictive performance was not statistically different from MOS bending rigidity (P > 0.05). 结果：前屈椎体强度不适合用基于QCT测定的BMD及MOS数据进行测定（R2= 0.14–0.22）。而通过QCT建立的FE模型能较好的测定前屈椎体强度（R2= 0.34–0.40），然而，其测定能力在统计学上与MOS无差别（P > 0.05）。Conclusions. Our results suggest that the poor clinical performance of noninvasive structural measures may be due to their inability to predict vertebral strength under bending loads. While their performance was not statistically better than MOS bending rigidities, QCT-based FE models were moderate predictors of both compressive and bending loads at failure, suggesting that this technique has the potential for strength prediction under nonuniform loads. The current FE modeling strategy is insufficient, however, and significant modifications must be made to better mimic whole bone elastic and inelastic material behavior.结论：结果表明，无创结构分析技术临床测量性差，可能因为其不能测定椎体在屈曲负荷下的椎体强度。其性能与MOS在统计学上无差异，通过QCT建立的FE模型在上述两者失败时可以作为压缩及屈曲负荷下的合适测定者。表明这一技术有测定不均衡负荷下椎体强度的潜力。然而，现有的FE模型是不足的，必须作有效的修正来更好地模拟整个骨的弹性及非弹性材料特性。Key words: osteoporosis, fracture, bending, vertebra, finite element, quantitative computed tomography. 关键词：骨质疏松症，骨折，屈曲，椎体，有限元，QCTMinimum 5-Year Follow-up Surgical Results of Post-traumatic Thoracic and Lumbar Kyphosis Treated With Anterior Instrumentation: Comparison of Anterior Plate and Dual Rod Systems前路内固定治疗胸腰椎创伤后驼背最少5年随访的手术结果：前路钢板与双棒系统的对比研究[Clinical Case Series]AbstractStudy Design. A retrospective follow-up study of post-traumatic thoracic and lumbar kyphosis after anterior instrumentation with anterior plate and dual rod systems.研究设计：应用前路钢板和双棒系统两种前路内固定治疗胸腰椎创伤后驼背的回顾性随访研究。Objective. To investigate the outcome of anterior vertebrectomy, anterior strut grafting, and anterior instrumentation in patients with >30° sagittal contour deformity.目的：调查矢状位上大于30°的成角畸形患者，应用前路椎体切除，前路支撑性植骨，前路内固定处理后的结果。Summary of Background Data. Post-traumatic kyphosis may lead to mechanical pain due to the impairment of physiologic sagittal contours as well as cosmetic complaints.背景资料概述：创伤后的驼背畸形由于其对脊柱生理曲度的破坏可能导致机械性的疼痛，也会导致美容（外貌）上的病态。Methods. Forty patients with post-traumatic kyphosis were followed for a minimum of 5 years. Mean age was 44.7 ± 12.4 years (range, 18–65 years); 18 were female and 22 were male. All patients underwent anterior vertebrectomy and decompression; anterior fusion was carried out with costal or iliac ala grafts. Patients were randomly assigned into 2 treatment groups: correction and internal fixation was performed by using either plate-screw (n = 20) or double rod-screw (n = 20). Patients were also evaluated clinically by using Pain and Functional Assessment Scale (PFA) and SRS-22 questionnaire.方法：对40例创伤后驼背的患者进行了最少5年的随访。平均年龄为44.7 ± 12.4岁 (范围在18–65岁之间)；女性18例，男性22例。所有患者均进行了前路椎体切除减压，并用肋骨或髂骨进行了前路植骨融合。所有患者都随机地分配到两个处理组：应用钢板螺钉（n=20）或双棒螺钉（n=20）进行矫正内固定。应用疼痛和功能评分（PFA）和SRS-22调查表对患者进行临床评价。Results. Before surgery, the mean value for local sagittal contours was 51.4° ± 13.8°; after surgery, it was reduced to 7.0° ± 7.6°, resulting in an 88.7% ± 11.3% correction (P = 0.00). At the last follow-up visit, a mean correction loss of 1.4° ± 1.8° was found. A statistically significant improvement in local kyphosis angles and PFA scores was found after surgery and at the last visit. In 92.5% of the patients (n = 36), pain completely resolved; and in the remaining 3 patients, it is markedly reduced. Neurologic improvement was achieved in all of the 24 patients with neural claudication and other neurologic findings. Solid fusion mass was obtained in all patients. The type of instrumentation system did not differ significantly in terms of kyphotic deformity correction rates, correction losses, PFA scores, and SRS-22 scores. Final PFA scores showed a statistically significant correlation with SRS-22 scores (r = -0.918, P < 0.01). Final pain, function, mental status, self image and satisfaction domain scores and total SRS-22 score were >=4. The time from trauma to operation and the severity of kyphotic deformity were inversely correlated with postoperative correction rates. On the other hand, these 2 parameters were positively correlated with both final PFA and final SRS-22 scores (P < 0.01).结果：术前，局部矢状位上成角的平均值为51.4° ± 13.8°，手术后，减小到7.0° ± 7.6°，结果得到了88.7% ± 11.3%的矫正(P = 0.00)。在最后一次随访时，发现矫正平均丢失了1.4° ± 1.8°。手术后和最后随访时相比，局部后凸角和PFA评分的改善方面的差异有统计学意义。92.5%的患者（n=36）疼痛得到了完全缓解，剩下的患者中有3例也得到了明显减轻。在所有24例有神经源性跛行或其他神经症状的患者中，神经症状都得到了改善。所有患者都得到了坚固的融合。在驼背畸形矫正率、矫正丢失、PFA评分和SRS-22评分等方面，不同类型内固定系统之间的差异没有统计学意义。最后的PFA评分与SRS-22评分之间显示出了有统计学意义的相关性(r = -0.918, P < 0.01)。最后的疼痛、功能、精神状态、自我形象及满意度评分和总的SRS-22评分均>=4。从受伤到手术的时间和驼背畸形的严重程度与手术后矫正率之间呈负相关。另一方面，这两个参数都与最后PFA评分和最后SRS-22评分成正相关(P < 0.01)。Conclusions. In light of the present study's findings, we suggest that the technique of anterior decompression, strut grafting, and anterior instrumentation is an effective method for the treatment of post-traumatic kyphotic deformity and that the success of the technique depends on the time from trauma to operation and the severity of baseline deformity, regardless of the type of instrumentation.结论：从目前的研究发现来看，我们建议，前路减压支撑性植骨，前路内固定的方法是治疗创伤后驼背畸形的有效手段，而且这一方法的成功取决于从受伤后到手术的时间，原始畸形的严重程度等，但与内固定的类型无关。Key words: post-traumatic kyphosis; surgical treatment; anterior instrumentation关键词：创伤后驼背；手术疗法；前路内固定Treatment of Vertebral Osteomyelitis by Radical Debridement and Stabilization Using Titanium Mesh Cages彻底清创应用钛（网）笼固定治疗椎体骨髓炎[Clinical Case Series]AbstractStudy Design. A retrospective clinical and radiologic evaluation of patients with vertebral osteomyelitis treated via radical debridement and stabilization using titanium mesh cages.研究设计：对经彻底清创应用钛（网）笼固定的椎体骨髓炎患者，进行回顾性的临床和放射学评估。Objective. To assess the efficacy of titanium mesh cages in the treatment of active vertebral osteomyelitis.目的：评价钛（网）笼在治疗活跃的椎体骨髓炎中的有效性。Summary of Background Data. Although titanium mesh cages have proven to be superior in trauma and tumor reconstructions, there are few reports regarding the use of titanium mesh cages in the presence of active pyogenic or tuberculotic vertebral osteomyelitis.背景资料概述：虽然已经证实钛（网）笼在创伤和肿瘤重建等方面有着明显的优势，但对于在活跃的化脓性或结核性椎体骨髓炎的情况下，应用钛（网）笼还少有相关的报道。Methods. A total of 88 cases with vertebral osteomyelitis were operated on between January 2000 and December 2002. There were 2 craniocervical, 13 cervical, 19 thoracic, 11 thoracolumbar, and 43 lumbar infections. The titanium mesh cages replaced 1 disc in 34 cases, 1 vertebral body in 28 cases, 2 vertebral bodies in 23 cases, and 3 vertebral bodies in 3 cases.方法：2000年1月至2002年12月期间，对88例椎体骨髓炎的患者进行手术治疗。这些感染中，颅颈部2例，颈部13例，胸椎19例，胸腰段11例，腰椎43例。钛（网）笼置换了1个椎间盘者有34例，1个椎体者28例，2个椎体者23例，3个椎体者有3例。Results. All patients showed a solid bony fusion without any recurrence of infection at latest follow-up. Changes in pain score, Frankel's classification, and blood parameters demonstrated a significant clinical improvement in all patients. The sagittal profile was restored.结果：在最后随访时，所有患者均显示出了可靠的骨性融合，且没有发生任何再发的感染。所有患者的疼痛评分、Frankel分级和血液参数等的改变，均显示出明显的临床改善。矢状位上的曲线也得到了恢复。Conclusions. The use of titanium mesh cages in the treatment of vertebral osteomyelitis effectively reconstructs the anterior column, while adding stability and restoring the sagittal profile. There is no increase in the rate of recurrence or persistence of infection related to the implantation of titanium mesh cages.结论：将钛（网）笼应用于治疗椎体骨髓炎，在增加脊柱稳定性，恢复矢状位上的曲线的同时，也有效地重建了前柱。没有因为钛（网）笼的植入而增加再发或持续感染的比率。Key words: vertebral osteomyelitis; titanium mesh cages; debridement; vertebral body replacement; pyogenic infection; tubercular infection关键词：椎体骨髓炎；钛（网）笼；清创术；椎体置换；化脓性感染；结核性感染Transplantation of Preconditioned Schwann Cells Following Hemisection Spinal Cord Injury. 脊髓半切损伤后预先处理的施万细胞移植 Abstract: 摘要：Study Design. Chronically compressed sciatic nerve segments were transplanted to hemisected spinal cord injured rats. Histologic evaluation and behavior functional outcomes were tested after 6 weeks following surgery. 研究设计：我们在脊髓半切损伤的大鼠身上移植了缓慢浓缩的坐骨神经节段。在术后第6周，我们评估了这些大鼠的组织学改变并检测了它们的行为功能情况。Objective. To evaluate the outcome of preconditioned peripheral nerves as a permissive environment in axonal regeneration of the injured spinal cord. 目标：评估预先处理的周围神经可否作为脊髓损伤轴性再生的有效的环境。Summary of Background Data. Schwann cells have been used to facilitate a permissive environment for the injured spinal cord to regenerate. Previous experiments have shown compressive mechanical stress to be important in stimulating the regenerative behavior of Schwann cells. Transplantation of highly permissive Schwann cell-enriched peripheral nerve grafts may enhance regeneration in spinal cord injury. 背景概述：施万细胞已经曾被用来创造脊索再生的有效环境辅助方法。先前的试验已经显示，在激发施万细胞的再生方面，保持一定的机械压力是十分重要的。而移植含有高浓度施万细胞的周围神经节段则可能可以加强脊索损伤的再生。Methods. Adult Sprague-Dawley rats (n = 24) were used to create a hemisection injury of the spinal cord. At 1-week postinjury creation, the spinal cords were reexposed for all animals. Peripheral nerve grafts were obtained from rat sciatic nerve, either untreated or subjected to mechanical compression for 2 weeks with nonconstrictive tubing. Transplantation of grafts was performed after a resection of the glial scar. Functional outcome was measured using the Basso, Beattie, Bresnahan Locomotor Rating Score and footprint analysis. Tract tracing of descending and ascending spinal cord tracts was performed at 6 weeks after surgery for histologic evaluation of axonal regeneration. 方法：我们用成年斯普拉-道来(氏)大鼠（n＝24）创造了脊髓半切损害的模型。在伤后1周，我们重新暴露了所有试验动物损伤的脊索。我们从大鼠的坐骨神经中获得了周围神经节段，它们有的接受了2周的机械浓缩（使用压缩管），而有的则没有。在除去神经胶质疤痕后，我们在受损脊索上移植了这些周围神经。通过Basso, Beattie, Bresnahan Locomotor运动评分和足迹法分析，我们测定了它们的功能表现。同时我们还在损伤后6周施行了脊索束上升和下降的束路追踪法，来作为轴性再生的组织学评估方法。Results. Preconditioned transplants had significantly higher Basso, Beattie, Bresnahan Scores versus hemisection alone in the late postoperative period (P < 0.05). They also had significantly less foot exorotation and base of support when compared to nonconditioned transplants. Histologic analysis showed increased regeneration at lesional sites for preconditioned transplants versus control group (P < 0.05). 结果：在半切损伤的模型中，在术后晚期，移植了预先处理的施万细胞组比仅受损伤组的Basso, Beattie, Bresnahan Locomotor运动评分要明显高得多（p<0.05）.与移植了没有预先处理的施万细胞组相比，它们同样有明显少的足外旋和基础支持。组织学分析则显示，与对照组相比，移植预先处理的施万细胞组病灶再生速度要快得多。Conclusions. Functional recovery after hemisection injury improved significantly in the late postoperative period with transplantation of preconditioned peripheral nerve. Preconditioned grafts also exhibit sustained axonal regeneration at and past the lesional site in histologic analysis. Further investigation with later time points is warranted.结论：半切损伤后移植预先处理的外周神经的术后晚期功能恢复要明显好得多。组织学分析显示预先处理的节段同样还表现出了持久的促进病灶轴性再生能力。我们希望在今后能做进一步的深入研究。Hybrid Testing of Lumbar CHARITE Discs Versus Fusions. 腰椎 CHARITE人工椎间盘与椎体融合的混合测试Abstract: 摘要：Study Design. An in vitro human cadaveric biomechanical study. 研究设计.一个体外人尸体生物学机制研究。Objectives. To quantify effects on operated and other levels, including adjacent levels, due to CHARITE disc implantations versus simulated fusions, using follower load and the new hybrid test method in flexion-extension and bilateral torsion. 目标：使用跟随负荷和新的混合测试方法，从屈曲-伸展和双向扭转两发面量化了接受CHARITE人工椎间盘或椎体融合术的手术节段以及其他相邻节段水平的效果。Summary of Background Data. Spinal fusion has been associated with long-term accelerated degeneration at adjacent levels. As opposed to the fusion, artificial discs are designed to preserve motion and diminish the adjacent-level effects. 背景概述：椎体融合术往往伴随长期的临近节段的退变加速。相对与融合术，人工椎间盘被设计用来保存椎体的运动并且减少相邻水平的效应。Methods. Five fresh human cadaveric lumbar specimens (T12-S1) underwent multidirectional testing in flexion-extension and bilateral torsion with 400 N follower load. Intact specimen total ranges of motion were determined with +/-10 Nm unconstrained pure moments. The intact range of motion was used as input for the hybrid tests of 5 constructs: 1) CHARITE disc at L5-S1; 2) fusion at L5-S1; 3) CHARITE discs at L4-L5 and L5-S1; 4) CHARITE disc at L4-L5 and fusion at L5-S1; and 5) 2-level fusion at L4-L5-S1. Using repeated-measures single factor analysis of variance and Bonferroni statistical tests (P < 0.05), intervertebral motion redistribution of each construct was compared with the intact. 方法：在承受400N负荷的状态下，5个新鲜的尸体椎骨样本(T12-S1)在屈曲－伸展和双向扭转方面接受了多方位的测试。完整的样本运动全范围被定义为+/-10 Nm单纯自由动量。这个完整的运动范围被作为下面5个结构的混合测试的输入量。1) 在L5-S1水平的CHARITE人工椎间盘。2)在L5-S1水平的椎体融合。3) L4-L5 和L5-S1水平的CHARITE人工椎间盘。4)在L4-L5的CHARITE人工椎间盘合并L5-S1的椎体融合。5) L4-L5-S1水平的联体融合。使用重复测量变异的单因子分析和Bonferroni统计学测试，我们将每个结构的椎间盘运动再分布与完整运动进行了比较。Results. In flexion-extension, 1-level CHARITE disc preserved motion at the operated and other levels, while 2-level CHARITE showed some amount of other-level effects. In contrast, 1- and 2-level fusions increased other-level motions (average, 21.0% and 61.9%, respectively). In torsion, both 1- and 2-level discs preserved motions at all levels. The 2-level simulated fusion increased motions at proximal levels (22.9%), while the 1-level fusion produced no significant changes. 结果：在伸展－屈曲方面，1级CHARITE人工椎间盘在手术以及相邻节段都保存了椎体的运动。而2级的CHARITE人工椎间盘则显示了一定的其他水平的效应。相对地，1级和2级的融合都增加了其他水平的运动（相对地平均21.0%和）61.9％）。在扭转力方面，1级和2级的椎间盘在所有水平都保存了运动。2级的融合增加了临近水平的运动(22.9%)，而1级融合则没有产生明显的改变。Conclusions. In general, CHARITE discs preserved operated- and other-level motions. Fusion simulations affected motion redistribution at other levels, including adjacent levels. 结论：概括地说，CHARITE人工椎间盘保持了手术和其他节段水平的运动。融合术则使包括相邻节段在内的其他节段水平的运动分布受到了影响。