胸腰椎后路截骨脊柱短缩术对脊髓功能及血流早期影响的实验研究
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摘要
目的：
本课题通过建立单节段(L1)环椎管脊椎截骨脊髓短缩动物模型,研究脊髓短缩对脊髓功能及血流的早期影响,从而对脊椎截骨的安全范围进行初步的动物实验研究,为临床截骨矫形手术提供一定的参考。
方法：
在动物实验中,选取成年雄性大耳家兔25只,体重2±0.4kg,体长35±5cm。将25只白兔随机分为5组,每组5只。3%的苯巴比妥耳缘静脉注射麻醉(30mg/kg)。A组为对照组,麻醉后行后路手术显露Ll的椎板及椎体,行环椎管脊椎截骨术,截骨后不压缩。B、C、D、E组为实验组(环椎管脊椎截骨脊髓短缩组),分别于麻醉成功后,通过后路手术行环椎管脊椎截骨。完成截骨后,分别压缩L1椎体总高度的25%、50%、75%、100%,并用高强度塑料线予以固定。
观察指标：
测量不同脊柱短缩程度下硬膜囊形态改变以评价硬膜皱缩程度。6h后用Jacobs分级,Reuters评分评价运动感觉功能,后将动物处死,行明胶墨汁血管灌注,切片观察并分析评价脊柱截骨节段脊髓内血容量,后取伤段脊髓切片,行组织病理学检查。
结果：
除A组,D组及E组各1只实验动物因手术原因死亡外,各组实验对象均完成实验测试项目。
1、各组自身对照：迂曲最大处硬膜囊横径和硬膜囊矢状位迂曲角在C、D、E组有显著性差别(P<0.01),手术后6小时Jacobs分级在C、D、E组有显著性差异(P<0.05), Reuters评分在B、C、D、E组均有显著性差异(P<0.05)。
2、组间对比：A组和B组的迂曲最大处硬膜囊横径、硬膜囊矢状位迂曲角、Jacobs评级、Reuters评分和SCBF均无显著性差异(P>0.05),其余脊髓各组间各指标均有显著性差异(P<0.05)。
3、相关性分析：硬膜囊横径、矢状位迂曲角改变及SCBF变化均与术后感觉运动评分呈显著相关(r=0.955,P<0.001；r=0.848,P<0.001；r=-0.869,P<0.001)。硬膜囊横径、矢状位迂曲角改变与SCBF变化也呈显著相关(r=-0.946,P<0.001；r=-0.997,P<0.001)。
4、病理学检查见脊髓损伤以水肿为主,神经元细胞肿胀,细胞核皱缩,周围水肿,神经纤维排列无规则,并见大片出血。随着脊髓短缩固定的距离增大,脊髓水肿面积越大,程度越重。
结论：
1、通过后路手术建立环脊椎截骨脊髓短缩模型是可行的,实验结果也可靠。
2、在兔脊髓短缩模型中,脊髓的短缩会造成脊髓功能的损伤和脊髓血流量的下降。
3、脊髓功能的损伤与脊髓短缩程度呈正相关,与脊髓血流量呈负相关。
4、脊髓血流量与脊髓短缩程度呈负相关。
5、在兔脊髓短缩模型中,规则的L1节段环椎管脊椎截骨的安全临界值为椎体总高度的50%
Objective:To establish a circumspinal vertebrectomy animal model of spinal cord shortening by the 1st lumber body vertebrectomy, and investigate the acute effects of spine shortening on the spinal morphous, function and blood flow.To make contribution to the security of vertebral osteotomy by researching the safe limits of spine column shortening.
Methods:25 male rabbits were randomly divided into five groups, the mean weights were 2±0.4kg and the mean lengths were 35±5cm.After general anesthesia and local anesthesia, Group A was the control group, which undergoing the 1st lumber body circumspinal vertebrectomy without docking. Group B,C,D,E were experimental groups, with the 1st lumber body circumspinal vertebrectomy. Then the two ends of osteotomy were docked different percent of lumber body length.It is grouped by docking 25%、50%、75%、100% percent of the 1st lumber body length.
Target:After total vertebral osteotomy of L1,we performed spinal column shortening and measured the diameter and length of spinal cord,the angle of the spinal sagittal circuity in different percent of shortening. Jacbos grade and Reuters score were recorded 6 hours after surgery. Then the animals were executed. Blood vessels casting preferred to the harvesting of spinal cord samples. The micropictures of the spinal slides were acquired with the aid of picture collecting system. Then it was ready to obtain the data of average vessel area of each group, which is calculated via a picture analying system. Then studied the H-E slides in pathology.
Results:Three animals were excluded in group A, D and E respectively because of the accident of operation.
1.Self control in every group:diameter of spinal cord and sagittal circuity existed statistic significance in group C,D and E(P<0.01),after 6 hours' observation, there were no statistic significance in the Jacobs grade between group A and B(P> 0.05),and existed statistic significance in group C,D,E(P<0.05).There were statistic significance in Reuters scores in group B, C, D, E.
2.Group control:the diameter and the sagittal circuity of spinal cord, Jacobs grade, Reuters scores and SCBF between group A and B did not exist statistic significance(P>0.05),others had statistic significance(P<0.05).
3.Correlations:the diameter, sagittal circuity and SCBF were all statistically correlated with Reuters scores(r=0.955,P<0.001;r=0.848,P<0.001; r=-0.869,P< 0.001).The diameter and sagittal circuity were correlated with SCBF(r=-0.946,P< 0.001;r=-0.997,P<0.001)
4.The manifestation of histopathology was swelling neurons, shrinking nucleus, irregularly nervous fibers. The longer distance of the spinal is docked the larger area of the neurons swell.
Conclusion:
1.Animal model of spinal shortening is successful with posterior total osteotomy of vertebra and internal fixation. It is feasible and reasonable.
2. Shortening of spine will damage the function and blood flow of spinal cord
3.The damage of spinal cord function has positive correlation with shortening of spine, and has negative correlation with SCBF
4.SCBF has negative correlation with shortening of spine
5.The safe limit of spine shortening in L1 is about 50% of its total height.
本课题通过建立单节段(L1)环椎管脊椎截骨脊髓短缩动物模型,研究脊髓短缩对脊髓功能及血流的早期影响,从而对脊椎截骨的安全范围进行初步的动物实验研究,为临床截骨矫形手术提供一定的参考。
方法：
在动物实验中,选取成年雄性大耳家兔25只,体重2±0.4kg,体长35±5cm。将25只白兔随机分为5组,每组5只。3%的苯巴比妥耳缘静脉注射麻醉(30mg/kg)。A组为对照组,麻醉后行后路手术显露Ll的椎板及椎体,行环椎管脊椎截骨术,截骨后不压缩。B、C、D、E组为实验组(环椎管脊椎截骨脊髓短缩组),分别于麻醉成功后,通过后路手术行环椎管脊椎截骨。完成截骨后,分别压缩L1椎体总高度的25%、50%、75%、100%,并用高强度塑料线予以固定。
观察指标：
测量不同脊柱短缩程度下硬膜囊形态改变以评价硬膜皱缩程度。6h后用Jacobs分级,Reuters评分评价运动感觉功能,后将动物处死,行明胶墨汁血管灌注,切片观察并分析评价脊柱截骨节段脊髓内血容量,后取伤段脊髓切片,行组织病理学检查。
结果：
除A组,D组及E组各1只实验动物因手术原因死亡外,各组实验对象均完成实验测试项目。
1、各组自身对照：迂曲最大处硬膜囊横径和硬膜囊矢状位迂曲角在C、D、E组有显著性差别(P<0.01),手术后6小时Jacobs分级在C、D、E组有显著性差异(P<0.05), Reuters评分在B、C、D、E组均有显著性差异(P<0.05)。
2、组间对比：A组和B组的迂曲最大处硬膜囊横径、硬膜囊矢状位迂曲角、Jacobs评级、Reuters评分和SCBF均无显著性差异(P>0.05),其余脊髓各组间各指标均有显著性差异(P<0.05)。
3、相关性分析：硬膜囊横径、矢状位迂曲角改变及SCBF变化均与术后感觉运动评分呈显著相关(r=0.955,P<0.001；r=0.848,P<0.001；r=-0.869,P<0.001)。硬膜囊横径、矢状位迂曲角改变与SCBF变化也呈显著相关(r=-0.946,P<0.001；r=-0.997,P<0.001)。
4、病理学检查见脊髓损伤以水肿为主,神经元细胞肿胀,细胞核皱缩,周围水肿,神经纤维排列无规则,并见大片出血。随着脊髓短缩固定的距离增大,脊髓水肿面积越大,程度越重。
结论：
1、通过后路手术建立环脊椎截骨脊髓短缩模型是可行的,实验结果也可靠。
2、在兔脊髓短缩模型中,脊髓的短缩会造成脊髓功能的损伤和脊髓血流量的下降。
3、脊髓功能的损伤与脊髓短缩程度呈正相关,与脊髓血流量呈负相关。
4、脊髓血流量与脊髓短缩程度呈负相关。
5、在兔脊髓短缩模型中,规则的L1节段环椎管脊椎截骨的安全临界值为椎体总高度的50%
Objective:To establish a circumspinal vertebrectomy animal model of spinal cord shortening by the 1st lumber body vertebrectomy, and investigate the acute effects of spine shortening on the spinal morphous, function and blood flow.To make contribution to the security of vertebral osteotomy by researching the safe limits of spine column shortening.
Methods:25 male rabbits were randomly divided into five groups, the mean weights were 2±0.4kg and the mean lengths were 35±5cm.After general anesthesia and local anesthesia, Group A was the control group, which undergoing the 1st lumber body circumspinal vertebrectomy without docking. Group B,C,D,E were experimental groups, with the 1st lumber body circumspinal vertebrectomy. Then the two ends of osteotomy were docked different percent of lumber body length.It is grouped by docking 25%、50%、75%、100% percent of the 1st lumber body length.
Target:After total vertebral osteotomy of L1,we performed spinal column shortening and measured the diameter and length of spinal cord,the angle of the spinal sagittal circuity in different percent of shortening. Jacbos grade and Reuters score were recorded 6 hours after surgery. Then the animals were executed. Blood vessels casting preferred to the harvesting of spinal cord samples. The micropictures of the spinal slides were acquired with the aid of picture collecting system. Then it was ready to obtain the data of average vessel area of each group, which is calculated via a picture analying system. Then studied the H-E slides in pathology.
Results:Three animals were excluded in group A, D and E respectively because of the accident of operation.
1.Self control in every group:diameter of spinal cord and sagittal circuity existed statistic significance in group C,D and E(P<0.01),after 6 hours' observation, there were no statistic significance in the Jacobs grade between group A and B(P> 0.05),and existed statistic significance in group C,D,E(P<0.05).There were statistic significance in Reuters scores in group B, C, D, E.
2.Group control:the diameter and the sagittal circuity of spinal cord, Jacobs grade, Reuters scores and SCBF between group A and B did not exist statistic significance(P>0.05),others had statistic significance(P<0.05).
3.Correlations:the diameter, sagittal circuity and SCBF were all statistically correlated with Reuters scores(r=0.955,P<0.001;r=0.848,P<0.001; r=-0.869,P< 0.001).The diameter and sagittal circuity were correlated with SCBF(r=-0.946,P< 0.001;r=-0.997,P<0.001)
4.The manifestation of histopathology was swelling neurons, shrinking nucleus, irregularly nervous fibers. The longer distance of the spinal is docked the larger area of the neurons swell.
Conclusion:
1.Animal model of spinal shortening is successful with posterior total osteotomy of vertebra and internal fixation. It is feasible and reasonable.
2. Shortening of spine will damage the function and blood flow of spinal cord
3.The damage of spinal cord function has positive correlation with shortening of spine, and has negative correlation with SCBF
4.SCBF has negative correlation with shortening of spine
5.The safe limit of spine shortening in L1 is about 50% of its total height.
引文
[1]LI Lang,SUN Jun,LI Ming,et al. The perfusion method for making brain vessel model by Chinese ink combined with gelation on the warm condition.Chinesejournal of clinical anatomy,2004,22(2):224
[2]Jacbos TP,Schobami E,Baze W,et al. Deteriorating stroke model:histopathology,edema and cicosannoid changes following spinal cord ischemia in rabbits.Stroke 1987,18(4):741-750
[3]Reuter DG,Tacker WA Jr,Badylak SF,et al.Correlationship of motor-evoked potential response to ischemia spinal cord damage.J Thorac Cardiovas Surg.1992,104(2):262-272
[4]Smith-Peterson MN Osteotomy of the spine for correction deformity in rheumatoid arthritis.J Bone Joint Surg,1945,27(1):1
[5]田慧中.对“脊柱截骨术”一词的商榷,中国脊柱脊髓杂志,1991,1(2)：83
[6]姚长海,刘汝落,侯树勋,等.多节段脊柱截骨手术并发症,中国脊柱髓杂志,1995,2(5)：8-10
[7]Suzman MS, Talmor M, Jennis R, et al. Accurate localization and surgical management of active lower gastrointestinal hemorrhage with technetium-labeled erythrocyte scintigraphy. Ann Surg,1996,224(1):29-36
[8]鲁开智,等.99 Tcm标记红细胞检测肝功能衰竭患者肝移植术中的有效容量变化,第三军医大学学报,2006,28(9)：984-986
[9]原所茂.脊椎截骨致脊髓短缩对脊髓血流及功能早期影响的实验研究,[硕士学位论文],济南,山东大学,2006
[10]张光铂.对“全脊柱截骨术”名词的商榷.中国脊柱脊髓杂志,1997,(1)：9
[11]MacEwen GD,Bunnell WE Srirarn K. Acute neurological complications in the treatment of scoliosis. A report of the Scoliosis Research Society. J Bone JointSurgAm.1975,57(3):404-408
[12]Pedrals JG. spinal shortening in scoliosis surgery.A case with transitory paraplegia. Spine,1996,21(21):2515-2519
[13]沈宁江,王书成,等.皮层体感诱发电位在评价脊柱脊髓损伤中的意义,骨与关节损伤杂志,1996,11(5)：275-277
[14]全力新.脊柱侧凸矫正手术的麻醉处理,中国实用医药,2007,2(16)：66-67
[15]高梁斌.椎弓椎体截骨矫正驼背的动物模型复制,中华实验外科杂志, 1994,11(2)：85-86
[16]刘新宇,郑燕平,脊椎截骨后脊柱短缩安全范围的实验研究,中华骨科杂志,2009,29(5)：503-507
[17]刘晓琪,脊柱截骨短缩对脊髓形态,结构及功能影响的实验研究,[硕士学位论文],长春,吉林大学,2008
[18]Kawahara N, Tomita K, Kobayashi T, et al.Influence of acute shortening on the spinal cord:an experimental study. Spine,2005,30:613-620
[19]陈裕光,李佛保.TMS-MEP与CSEP诊断脊髓损伤的作用比较,临床骨科杂志,1998,1(2)：79-82
[20]Ducker TB,Assenmacher DR.Microvascular response to experimental spinal cord trauma. Surg Forum,1969,20:428-430
[21]Dohrmann GJ,Wagner FC,Bucy PC.The microvasculature in transitory traumatic paraplegia. An electron microscopic study in the monkey. J Nenrosurg,1971, 35:263-271
[22]Wagner F,Taslitz N, White lU,et al: Vascular phenomena in the normal and traumatized spinal cord. Anat Rec,1969,163:281 (Abstract)
[23]Bingham WG,Goldman H,Friedman SJ,et al:Blood flow in normal and injured monkey spinal cord. J Nenrosurg,1975,43:162-171
[24]Lindsberg PJ, O'Neill JT, Paakkari IA, et al. Validation of Laser-Doppler flowmetry in measurement of spinal cord blood flow. AmJ Physiol,1989,257:674.
[25]Howard JS, Joan LV. Altered blood flow and secondary injury in experimentalspinal cord trauma. J Nenrosurg,1978,49:569-578
[26]Tomonon Y, Tetsuya M, Himyuki N, et al. Spinal cord blood flow and pathophysiological changes after transient spinal cord ischemia in cats, Nenrosurgary,1998,42(3):626-634
[1]Smith-Peterson MN, Osteotomy of the spine for correction deformity in rheumatoid arthritis.J Bone Joint Surg,1945,27; 1
[2]Hehne HJ, Zielke K, Bohm H. Polysegmental lumber osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis:report on 177 case [J]. Clin Orthop,1990,258:49-55
[3]Scudese VA, Calabro JJ.Vertebral wedge osteotomy [J]. JAMA,1963,186:104.
[4]Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis [J]. Clin Orthop,1985,194:142-152
[5]姜洪和,王长纯,张承敏等,多节段全脊椎截骨术矫正脊柱后凸畸形[J].中国脊柱脊髓杂志,1991,1(1)：20-22
[6]齐强,陈仲强,郭昭庆等,脊柱前方垫高-后方闭合截骨矫形术治疗胸腰段脊柱后凸畸形的初步报告[J].中华外科杂志,2006,44(8)：551-555
[7]Kawahara N, Tomita K, Baba H, et al. Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach [J].Spine,2001,26(4):391-402
[8]姚长海,刘汝落,侯树勋等,多节段脊柱截骨手术并发症,中国脊柱髓杂志,1995,2(5)：8-10
[9]Bradford DS, Tribus CB. Vertebral column resection for the treatment of rigid coronal decompensation [J].Spine,1997,22(14):1590-1599
[10]Berven SH, Deviren V, Smith JA, et al. Management of fixed sagittal plane deformity:results of the transpedicular wedge resection osteotomy [J]. Spine,2001, 26(18):2036-2043
[11]史亚民,侯树勋,王华东,等.后路椎体截骨矫正僵硬性脊柱侧后凸[J].中华骨科杂志,2004,24(5)：266-269
[12]赵新建.全脊椎截骨术使脊髓短缩对脊髓功能影响的临床观察,中国脊柱脊髓杂志,1997,7(5)：196-198
[13]高梁斌,李健,李佛保,等.强直性脊柱炎脊柱后凸截骨矫正量的临床研究,广东医学,2002,23(1)：38-39.
[14]Gertzbein SD, Harris MB. Wedge osteotomy for the correction of post-traumatic kyphosis [J]. Spine,1992,17(3):374-379.
[15]Bridwell KH, Kuklo TR, Lewis SJ, et al. String test measurement to assess the effect of spinal deformity correction on spinal canal length [J]. Spine,2001, 26(18):2013-2019.
[16]de Medinaceli L, Wyatt RJ. A method for shortening of the rat spine and its neurologic consequences [J]. J Neural Transplant Plast,1993,4(1):39-52
[17]Braun JT, Ogilivie JW, Akyuz E, et al. Experimental scoliosis inan immature goat model:a method that creates idiopathic-type peformity with minimal violation of the spinal elements alongthe curve [J]. Spine,2003,28(19):2198-2203
[18]刘新宇,郑燕平,李建民,王延国,张凯,贾龙,官良泰脊椎截骨后脊柱短缩安全范围的实验研究平[J] 中华骨科杂志2009,5(29)：503
[19]鲁开智等,99 Tcm标记红细胞检测肝功能衰竭患者肝移植术中的有效容量变化,第三军医大学学报,2006,28(9)：984-986
[20]原所茂,脊椎截骨致脊髓短缩对脊髓血流及功能早期影响的实验研究,[硕士学位论文],济南,山东大学,2006
[21]李长有,王星铎,应用激光多普勒血流仪监测兔急性脊髓缺血损伤后腰髓血流动力学变化及病理学观察的研究,中国骨科杂志,1997,17(5)：299-303.
[22]陈裕光,李佛保,TMS-MEP与CSEP诊断脊髓损伤的作用比较,临床骨科杂志,1998,1(2),79-82
[23]高梁斌,廖维宏,胡文辉,等.脊髓纵向压缩过程中脊髓诱发电位、血流量和微循环变化[J].中国脊柱脊髓杂志,1992,2(5)：209-211
[24]高梁斌,徐海荣,廖维宏.椎弓椎体截骨矫正驼背的动物模型复制[J].中华实验外科杂志,1994,11(2)：85-86
[25]Kawahara N, Tomita K, Kobayashi T, et al.Influence of acute shortening on the spinal cord:an experimental study. Spine,2005,30:613-620
[26]Dolam EJ, Transfeldt EE, Tator CH, et al. The effect of spinaldistraction on regional spinal cord blood flow in cats [J].Neurosurg,1980,53:755-764
[27]毛方敏,宋跃明,池永龙.牵张性脊髓损伤脊髓SCEP监护作用的实验研究[J].中国脊柱脊髓杂志,1998,8(2)：83-86
[28]倪春鸿,李明,侯铁胜,等.脊髓急性牵拉损伤动物模型机理研究[J].脊柱外科杂志,2004,2(5)：285-288
[29]Howard JS, Joan LV. Altered blood flow and secondary injury in experimental spinal cord trauma. J Nenrosurg,1978.49:569-578
[30]Tomonori Y Tetsuya M, Himyuki N, et al. Spinal cord blood flow and pathophysiological changes after transient spinal cord ischemia in eats. Nenrosurgary,1998,42(3):626-634
[2]Jacbos TP,Schobami E,Baze W,et al. Deteriorating stroke model:histopathology,edema and cicosannoid changes following spinal cord ischemia in rabbits.Stroke 1987,18(4):741-750
[3]Reuter DG,Tacker WA Jr,Badylak SF,et al.Correlationship of motor-evoked potential response to ischemia spinal cord damage.J Thorac Cardiovas Surg.1992,104(2):262-272
[4]Smith-Peterson MN Osteotomy of the spine for correction deformity in rheumatoid arthritis.J Bone Joint Surg,1945,27(1):1
[5]田慧中.对“脊柱截骨术”一词的商榷,中国脊柱脊髓杂志,1991,1(2)：83
[6]姚长海,刘汝落,侯树勋,等.多节段脊柱截骨手术并发症,中国脊柱髓杂志,1995,2(5)：8-10
[7]Suzman MS, Talmor M, Jennis R, et al. Accurate localization and surgical management of active lower gastrointestinal hemorrhage with technetium-labeled erythrocyte scintigraphy. Ann Surg,1996,224(1):29-36
[8]鲁开智,等.99 Tcm标记红细胞检测肝功能衰竭患者肝移植术中的有效容量变化,第三军医大学学报,2006,28(9)：984-986
[9]原所茂.脊椎截骨致脊髓短缩对脊髓血流及功能早期影响的实验研究,[硕士学位论文],济南,山东大学,2006
[10]张光铂.对“全脊柱截骨术”名词的商榷.中国脊柱脊髓杂志,1997,(1)：9
[11]MacEwen GD,Bunnell WE Srirarn K. Acute neurological complications in the treatment of scoliosis. A report of the Scoliosis Research Society. J Bone JointSurgAm.1975,57(3):404-408
[12]Pedrals JG. spinal shortening in scoliosis surgery.A case with transitory paraplegia. Spine,1996,21(21):2515-2519
[13]沈宁江,王书成,等.皮层体感诱发电位在评价脊柱脊髓损伤中的意义,骨与关节损伤杂志,1996,11(5)：275-277
[14]全力新.脊柱侧凸矫正手术的麻醉处理,中国实用医药,2007,2(16)：66-67
[15]高梁斌.椎弓椎体截骨矫正驼背的动物模型复制,中华实验外科杂志, 1994,11(2)：85-86
[16]刘新宇,郑燕平,脊椎截骨后脊柱短缩安全范围的实验研究,中华骨科杂志,2009,29(5)：503-507
[17]刘晓琪,脊柱截骨短缩对脊髓形态,结构及功能影响的实验研究,[硕士学位论文],长春,吉林大学,2008
[18]Kawahara N, Tomita K, Kobayashi T, et al.Influence of acute shortening on the spinal cord:an experimental study. Spine,2005,30:613-620
[19]陈裕光,李佛保.TMS-MEP与CSEP诊断脊髓损伤的作用比较,临床骨科杂志,1998,1(2)：79-82
[20]Ducker TB,Assenmacher DR.Microvascular response to experimental spinal cord trauma. Surg Forum,1969,20:428-430
[21]Dohrmann GJ,Wagner FC,Bucy PC.The microvasculature in transitory traumatic paraplegia. An electron microscopic study in the monkey. J Nenrosurg,1971, 35:263-271
[22]Wagner F,Taslitz N, White lU,et al: Vascular phenomena in the normal and traumatized spinal cord. Anat Rec,1969,163:281 (Abstract)
[23]Bingham WG,Goldman H,Friedman SJ,et al:Blood flow in normal and injured monkey spinal cord. J Nenrosurg,1975,43:162-171
[24]Lindsberg PJ, O'Neill JT, Paakkari IA, et al. Validation of Laser-Doppler flowmetry in measurement of spinal cord blood flow. AmJ Physiol,1989,257:674.
[25]Howard JS, Joan LV. Altered blood flow and secondary injury in experimentalspinal cord trauma. J Nenrosurg,1978,49:569-578
[26]Tomonon Y, Tetsuya M, Himyuki N, et al. Spinal cord blood flow and pathophysiological changes after transient spinal cord ischemia in cats, Nenrosurgary,1998,42(3):626-634
[1]Smith-Peterson MN, Osteotomy of the spine for correction deformity in rheumatoid arthritis.J Bone Joint Surg,1945,27; 1
[2]Hehne HJ, Zielke K, Bohm H. Polysegmental lumber osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis:report on 177 case [J]. Clin Orthop,1990,258:49-55
[3]Scudese VA, Calabro JJ.Vertebral wedge osteotomy [J]. JAMA,1963,186:104.
[4]Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis [J]. Clin Orthop,1985,194:142-152
[5]姜洪和,王长纯,张承敏等,多节段全脊椎截骨术矫正脊柱后凸畸形[J].中国脊柱脊髓杂志,1991,1(1)：20-22
[6]齐强,陈仲强,郭昭庆等,脊柱前方垫高-后方闭合截骨矫形术治疗胸腰段脊柱后凸畸形的初步报告[J].中华外科杂志,2006,44(8)：551-555
[7]Kawahara N, Tomita K, Baba H, et al. Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach [J].Spine,2001,26(4):391-402
[8]姚长海,刘汝落,侯树勋等,多节段脊柱截骨手术并发症,中国脊柱髓杂志,1995,2(5)：8-10
[9]Bradford DS, Tribus CB. Vertebral column resection for the treatment of rigid coronal decompensation [J].Spine,1997,22(14):1590-1599
[10]Berven SH, Deviren V, Smith JA, et al. Management of fixed sagittal plane deformity:results of the transpedicular wedge resection osteotomy [J]. Spine,2001, 26(18):2036-2043
[11]史亚民,侯树勋,王华东,等.后路椎体截骨矫正僵硬性脊柱侧后凸[J].中华骨科杂志,2004,24(5)：266-269
[12]赵新建.全脊椎截骨术使脊髓短缩对脊髓功能影响的临床观察,中国脊柱脊髓杂志,1997,7(5)：196-198
[13]高梁斌,李健,李佛保,等.强直性脊柱炎脊柱后凸截骨矫正量的临床研究,广东医学,2002,23(1)：38-39.
[14]Gertzbein SD, Harris MB. Wedge osteotomy for the correction of post-traumatic kyphosis [J]. Spine,1992,17(3):374-379.
[15]Bridwell KH, Kuklo TR, Lewis SJ, et al. String test measurement to assess the effect of spinal deformity correction on spinal canal length [J]. Spine,2001, 26(18):2013-2019.
[16]de Medinaceli L, Wyatt RJ. A method for shortening of the rat spine and its neurologic consequences [J]. J Neural Transplant Plast,1993,4(1):39-52
[17]Braun JT, Ogilivie JW, Akyuz E, et al. Experimental scoliosis inan immature goat model:a method that creates idiopathic-type peformity with minimal violation of the spinal elements alongthe curve [J]. Spine,2003,28(19):2198-2203
[18]刘新宇,郑燕平,李建民,王延国,张凯,贾龙,官良泰脊椎截骨后脊柱短缩安全范围的实验研究平[J] 中华骨科杂志2009,5(29)：503
[19]鲁开智等,99 Tcm标记红细胞检测肝功能衰竭患者肝移植术中的有效容量变化,第三军医大学学报,2006,28(9)：984-986
[20]原所茂,脊椎截骨致脊髓短缩对脊髓血流及功能早期影响的实验研究,[硕士学位论文],济南,山东大学,2006
[21]李长有,王星铎,应用激光多普勒血流仪监测兔急性脊髓缺血损伤后腰髓血流动力学变化及病理学观察的研究,中国骨科杂志,1997,17(5)：299-303.
[22]陈裕光,李佛保,TMS-MEP与CSEP诊断脊髓损伤的作用比较,临床骨科杂志,1998,1(2),79-82
[23]高梁斌,廖维宏,胡文辉,等.脊髓纵向压缩过程中脊髓诱发电位、血流量和微循环变化[J].中国脊柱脊髓杂志,1992,2(5)：209-211
[24]高梁斌,徐海荣,廖维宏.椎弓椎体截骨矫正驼背的动物模型复制[J].中华实验外科杂志,1994,11(2)：85-86
[25]Kawahara N, Tomita K, Kobayashi T, et al.Influence of acute shortening on the spinal cord:an experimental study. Spine,2005,30:613-620
[26]Dolam EJ, Transfeldt EE, Tator CH, et al. The effect of spinaldistraction on regional spinal cord blood flow in cats [J].Neurosurg,1980,53:755-764
[27]毛方敏,宋跃明,池永龙.牵张性脊髓损伤脊髓SCEP监护作用的实验研究[J].中国脊柱脊髓杂志,1998,8(2)：83-86
[28]倪春鸿,李明,侯铁胜,等.脊髓急性牵拉损伤动物模型机理研究[J].脊柱外科杂志,2004,2(5)：285-288
[29]Howard JS, Joan LV. Altered blood flow and secondary injury in experimental spinal cord trauma. J Nenrosurg,1978.49:569-578
[30]Tomonori Y Tetsuya M, Himyuki N, et al. Spinal cord blood flow and pathophysiological changes after transient spinal cord ischemia in eats. Nenrosurgary,1998,42(3):626-634