经Kambin三角椎体问融合治疗腰椎退行性滑脱症

目的探讨经Kambin三角微创椎体间融合术（oblique lumbar interbody fusion,OLIF）治疗腰椎退行性滑脱的疗效。方法2012年4月～2013年4月对10例腰椎退行性滑脱导致的腰椎管狭窄行OLIF。以腰腿痛评分和疼痛视觉模拟评分（visual analogue scale,VAS）作为手术前后主、客观评分标准,分别对术前,术后1、6个月及末次随访进行临床评估,CT扫描评价愈合情况。结果手术时间60～95min,平均73min;术中出血量50～200ml,平均90ml。10例随访9～18个月,平均14个月,9例手术效果保持稳定,无断钉、松动,1例出现右侧L4神经根感觉支不全损害。术后腰腿痛缓解明显,术前后腰、腿痛VAS评分有统计学差异（F=88.45,P=0.000;F=27.54,P=0.000）,但术后不同时点腰腿痛VAS评分无统计学差异（P〉0.05）。结论OLIF方法简便,治疗腰椎退行性滑脱短期效果满意。     

中老年腰腿痛患者腰椎终板Modic改变的分布情况及其与腰椎不稳的关系

目的:探讨中老年腰腿痛患者腰椎终板Modic改变的分布情况,分析其与腰椎不稳之间的关系。方法:随机选取2007年3月~2011年12月因腰腿痛在我院行腰椎MRI和常规X线片检查的年龄≥40岁的患者430例,男210例,女220例,年龄40~73岁。观察患者腰椎终板Modic改变的发生率、类型及分布特点;根据腰椎是否稳定分为腰椎稳定组和腰椎不稳定组,分析其与Modic改变之间的关系;腰椎稳定组患者分为腰椎曲度正常组和异常组,分析其与Modic改变之间的关系。结果:430例共计2150个腰椎椎间盘中,124例(28.84%)154个(7.16%)椎间盘终板存在Modic改变,其中Ⅰ型34例(7.91%)、34个椎间盘(1.58%),Ⅱ型72例(16.74%)、100个椎间盘(4.65%),Ⅲ型18例(4.19%)、20个椎间盘(0.93%);L2/3 14个,L3/4 24个,L4/5 50个,L5/S1 66个,其发生率分别为0.65%、1.12%、2.32%、3.07%;其中Modic改变位于终板前部79个,后部31个,整个终板44个;仅累及上终板52个,仅累及下终板41个,累及上、下终板61个。腰椎不稳定组终板Modic改变的发生率为36.68%,腰椎稳定组为19.90%,两组差异有统计学意义(P<0.05);ModicⅠ、Ⅱ、Ⅲ型中腰椎不稳的发生率分别为82.35%、69.44%、33.33%,三者差异有统计学意义(P<0.05);腰椎曲度正常组终板Modic改变的发生率为11.11%,腰椎曲度异常组为23.91%,两组差异有统计学意义(P<0.05)。结论:中老年腰腿痛患者腰椎终板Modic改变以Ⅱ型最多见,以L4/5和L5/S1节段多发;其与腰椎不稳和腰椎曲度之间存在相关关系,ModicⅠ型改变与腰椎不稳相关性最强。     

腰椎不稳定与腰椎间盘退变程度的相关性分析

目的：探讨腰椎不稳定与腰椎间盘退变程度的相关性。方法：随机选择100例腰腿痛病人,根据第一病人的腰椎功能位X线片和腰椎MRI图片,确定椎间盘的退变程度及有无节段不稳,并分析二者间关系。结果：L3－S1共有36个节段不稳,占12％;腰椎不稳29例,占病人总数的29％,L4／5、L3／4、L5／S1的不稳定发生率分别为22％、10％和4％;腰椎不稳与病人年龄分组呈现密切正相关,腰椎不稳与单节段退变及总退变度密切正相关,结论：腰椎不稳与椎间盘退变和蔼密切相关,但并非严重退变一定会发生节段不稳。     

A square to indicate the unstable zone in severe spondylolisthesis

The reduction and stabilisation of high-grade dysplastic developmental spondylolisthesis by means of modern internal fixators can correct slip, but can leave the sagittal alignment unbalanced, causing instability, e.g. in the adjacent, non-fused lumbar segments. Through analysis of the modifications of imbalance in the spine and pelvic ring due to surgical correction, this study defines the unstable zone of high-grade dysplastic developmental spondylolisthesis and proposes a simple radiographic method to identify it.     

腰椎融合器在腰椎退行性病变治疗中的疗效分析

目的:分析80例使用腰椎融合器患者的疗效,评价腰椎融合器在治疗退行性病变腰椎疾病中的应用效果。方法:应用相对椎间隙高度、Taillard指数、腰椎曲线指数、节段前凸角、全腰椎前凸角等影像学检查指标及Greenough临床疗效标准,对80例使用腰椎融合器的腰椎退行性变的患者进行临床随访,对比分析术前术后及随访结果,评价治疗效果。结果:所有患者术前相对椎间隙高度平均为0·69(0·62~0·76),术后平均为1·24(1·14~1·34);Taillard指数术前平均为0·32(0·24~0·40),术后平均为0·03(0·02~0·04),手术疗效良好率达到91%。术后出现1例融合失败,发生率为1%。结论:腰融合器是治疗腰椎退行性病变的有效方法,应用时应掌握其准确的适应证和植入技术,避免并发症发生。     

腰椎间盘间孔突出症

腰椎间盘间孔突出症在腰椎间盘突出症中并非少见，诊断主要依据以下四点：（１）腿部症状严重；（２）典型神经障碍；（３）椎间手术后证实；（４）ＣＴ检查。本文详细讨论了该病的论断的技巧和效果。     

单纯黄韧带肥厚致腰椎管狭窄及根性疼痛

目的：探讨单纯黄韧带肥厚致腰椎管狭窄及根性疼痛的临床表现。方法：回顾1997年－2001年腰腿痛的143例病例，其中例为单纯黄韧带肥厚所致，年龄65－78岁，均手术行单纯黄韧带切除，达到椎管减压，结果：此类患者均为老年，病程长，可有急性加重过程，疼痛可与椎间盘突出相似，但以下腰疼痛明显，而下肢放射痛相对较轻，临床及影像学均易误诊。结论：退变引起的黄韧带肥厚可造成椎管狭窄及根性疼痛，手术切除后症状明显缓解。长期随访，患者腰痛消失，可以长时间行走，明显提高了生活质量。     

Spinal manipulation results in immediate H-reflex changes in patients with unilateral disc herniation

The aim of this clinical investigation was to determine whether the abnormal H-reflex complex present in patients with S 1 nerve root compression due to lumbosacral disc herniation is improved by single-session lumbar manipulation. Twenty-four patients with unilateral disc herniation at the L5-S1 level underwent spinal H-reflex electro-physiological evaluation. This was carried out before and after single-session lumbar manipulation in the side-lying position. Eligibility criteria for inclusion in the study were: predominant sciatica, no motor or sphincteric involvement, unilateral disc herniation at the L5-S1 level on CT or MR imaging, age between 20 and 50 years. H-reflex responses were recorded bilaterally from the gastrosoleous muscle following stimulation of tibial sensory fibers in the popliteal fossa. H-reflex amplitude in millivolts (HRA) and H-reflex latency in milliseconds (HR-L) were measured from the spinal reflex response. Pre- and post-manipulation measurements were compared between the affected side and the healthy side. Statistical evaluation was performed by the Wilcoxon matched-pairs test (SPSS). Thirteen patients displayed abnormal H-reflex parameters prior to lumbar manipulation, indicating an S1 nerve root lesion. The mean amplitude was found to be significantly lower on the side of disc herniation than on the normal, healthy side (P = 0.0037). Following manipulation, the abnormal HR-A increased significantly on the affected side while the normal HR-A on the healthy side remained unchanged (P = 0.0045). There was a significant difference between latencies on the affected side and those on the healthy side (P = 0.003). Following manipulation there was a trend toward decreased HR-L. However, this trend did not reach statistical significance (P = 0.3877). Eight patients displayed no H-reflex abnormalities before or after manipulation. Their respective HR-A and HR-L values did not change significantly following manipulation. Three additional patients were excluded due to technical difficulties in achieving manipulation or measuring spinal reflex. These observations may lend physiological support for the clinical effects of manipulative therapy in patients with degenerative disc disease.Presented in part at EURO SPINE, Zurich, 18 October 1996, the International Conference on Spinal Manipulation, Bournemouth, 19 October 1996, and the North American Spine Society Annual Meeting, Vancouver, 25 October 1996     

显微椎间盘切除治疗术后复发性腰椎间盘突出症

目的 评价显微椎间盘切除治疗复发性腰椎间盘突出症的临床疗效. 方法 18例复发性腰椎间盘突出症(再手术组)接受小切口显微腰椎间盘切除术,与30例初次显微手术(初手术组),比较两组手术时间、术中出血量与住院时间.术后疗效评价采用MacNab法. 结果 再手术组手术时间平均75 min;初手术组平均52 min;再手术组术中出血量平均70 ml;初手术组平均50 ml;再手术组术后住院时间平均8.5 d;初手术组平均6.5 d.再手术组术中损伤硬膜1例,2例腰5神经根损害加重,5例术后麻木加重,术后均恢复.初手术组术中硬膜损伤1例.再手术组17例获平均12.1个月随访,优良率为88.2%.初手术组29例获平均11.8个月随访,优良率为93.1%.两组疗效比较差异无统计学意义(P＞0.05). 结论 小切口显微椎间盘切除治疗复发性腰椎间盘突出症能取得与初次手术相近的临床疗效.     

微创显微腰椎间盘切除术的初步疗效评价

目的 评价微创显微腰椎间盘切除术初步疗效.方法 对单间隙腰椎间盘突出症接受管道扩张微创入路(METRx系统)显微腰椎间盘切除术(微创组)与传统手术(传统组)各34例,比较两组手术时间、术中出血量、术后下地时间与住院时间.视觉模拟评分(VAS)评价术后伤口疼痛.改良MacNab法评价疗效.结果 平均手术时间:微创组65 min,传统组63 min.术中平均出血量:微创组34 ml,传统组85ml.两组比较差异有统计学意义(P＜0.05).术后平均实际下地时间:微创组2.6 d,传统组5.8 d;术后平均住院时间:微创组5.8 d,传统组9.6 d;术后伤口疼痛平均VAS评分:微创组3.2分、传统组5.6分.两组比较差异有统计学意义(P＜0.05).并发症微创组1例,传统组4例;微创组33例获得平均8.5个月随访,优良率为93.9%,术后1例复发再次手术.结论 微创显微腰椎间盘切除术具有创伤小、安全、康复快的优点,能取得满意的疗效.     

腰椎间盘切除术后腰椎稳定性影响的临床研究——204例中、长期随访分析

目的探讨腰椎间盘突出症传统髓核切除术式对腰椎稳定性的影响。方法204例腰椎间盘突出症,采用椎板开窗,半椎板、全椎板减压行髓核摘除,分析中、长期腰椎的稳定性。结果中、长期随访,发生腰椎不稳14例。其中采用全椎板切除术式24例,有10例发生腰椎不稳,占全部腰椎不稳的71.4%。单一节段一侧椎板开窗术式119例,无腰椎不稳发生,椎间隙狭窄发生率为21.0%。结论单纯腰椎间盘突出症术前无动力性不稳者,仅行开窗髓核切除即可获得满意疗效,不必使用内固定融合以预防远期腰椎运动节段的不稳。     

Development of a clinical diagnosis support tool to identify patients with lumbar spinal stenosis

No clinical diagnostic support tool can help identify patients with LSS. Simple diagnostic tool may improve the accuracy of the diagnosis of LSS. The aim of this study was to develop a simple clinical diagnostic tool that may help physicians to diagnose LSS in patients with lower leg symptoms. Patients with pain or numbness of the lower legs were prospectively enrolled. The diagnosis of LSS by experienced orthopedic specialists was the outcome measure. Multivariable logistic regression analysis identified factors that predicted LSS; a simple clinical prediction rule was developed by assigning a risk score to each item based on the estimated beta-coefficients. From December 2002 to December 2004, 104 orthopedic physicians from 22 clinics and 50 hospitals evaluated 468 patients. Two items of physical examination, three items of patients' symptom, and five items of physical examination were included in the final scoring system as a result of multiple logistic regression analysis. The sum of the risk scores for each patient ranged from −2 to 16. The Hosmer–Lemeshow statistic was 11.30 (P = 0.1851); the area under the ROC curve was 0.918. The clinical diagnostic support tool had a sensitivity of 92.8% and a specificity of 72.0%. The prevalence of LSS was 6.3% in the bottom quartile of the risk score (−2 to 5) and 99.0% in the top quartile (12 to 16). We developed a simple clinical diagnostic support tool to identify patients with LSS. Further studies are needed to validate this tool in primary care settings.     

后路椎弓根钉内固定加椎间植骨融合治疗腰椎不稳症

目的探讨退变性腰椎不稳症的手术适应证及技术要点。方法对36例退变性腰椎不稳症行后路椎体间融合和上下关节突间植骨以及相应节段椎弓根钉内固定术。结果31例经8～31个月随访,平均14个月。依据日本JOA评分法;优良率87．1％。结论后路椎弓根钉内固定加椎间融合术是治疗重度退变性腰椎不稳症的有效手术方式。     

Correlation of spinopelvic parameters with functional outcomes in surgically managed cases of lumbar spinal tuberculosis- A retrospective study

BackgroundThe advanced stage of vertebral involvement in spinal tuberculosis (STB) can cause vertebral body collapse, which leads to kyphotic deformity and paraplegia in severe cases. Surgery is indicated in patients having disabling back pain, progressive neurological deficit, and instability in spine despite conservative management. The derangement of lumbar parameters, especially the loss of lumbar lordosis has been found to cause functional deterioration in patients. With the current evidences in place, this study was done to evaluate the correlation between the restoration of lumbar lordosis, pelvic parameters, and functional outcome when posterior only approach was used to manage the lumbar STB.MethodsActive Tuberculosis of lumbar vertebra (L1-S1) confirmed by radiology (X-ray, MRI) and histopathological examination were included. All the cases scheduled for surgery underwent radiographs, CT scan, and MRI scans. Lumbar lordosis and other pelvic parameters were calculated on X-rays. VAS scores and ODI scores were documented during the follow-up to assess functional well-being.ResultsA total of 33 (22 M:11 F) patients were included in the study. The mean lumbar lordosis pre-operatively was −22.84 ± 11.19° which was corrected to −37.03 ± 9.02° (p < 0.05) post-operatively. The pelvic tilt pre-operatively was 25.33 ± 6.75° which was corrected to 19.63 ± 5.84° (p < 0.05) post-operatively. The mean ODI improved from 84.33 ± 11.84 to 26.93 ± 8.74 (p < 0.05) at the final follow-up. The mean VAS score pre-operatively was 8.06 ± 1.27 which improved to 2.45 ± 0.93 (p < 0.05) in the post-operative period.ConclusionThe study found a strong negative correlation between ODI scores and lumbar lordosis and a strong positive correlation between pelvic tilt and ODI scores. But the correlation needs to be further studied and evaluated by a well-constructed study especially with a control group treated conservatively.     

改良Weinstin法在治疗腰椎峡部裂型滑脱中的应用

目的探讨改良Weinstin法在治疗腰椎峡部裂型滑脱中定位置钉点的准确性及临床效果。方法回顾性分析2008年1月至2012年12月期间的186例腰椎峡部裂型滑脱患者,按置针点定位方法分为改良Weinstin组105例,Weinstin组81例。比较两组病例的手术时间、术中和术后出血量、术前及术后3个月的疼痛视觉模拟量表(visual analogue scale,VAS)评分及Oswestry功能障碍指数(Oswestry disability index,ODI)评分、术后相关并发症、置钉准确性。结果改良Weinstin组,手术时间为(118.53±24.34)min,术中出血量为(278.28±85.30)mL,术后出血量为(238.92±90.02)mL;Weinstin组,手术时间为(143.34±32.84)min,术中出血量为(389.83±103.36)mL,术后出血量为(256.21±69.34)mL。两组间手术时间及术中出血量差异均具有统计学意义(均P<0.05),而术后出血量差异无统计学意义(P>0.05);两组术前及术后3个月的VAS及ODI差异均无统计学意义(均P>0.05);两组术后相关并发症及置钉准确性的差异无统计学意义(P>0.05)。结论改良Weinstin法操作简单,术中无需暴露横突,减少了手术时间,降低了术中出血量。     

骨质疏松症与腰椎管狭窄

方法：采用多节段开窗减压治疗腰椎管狭窄，报导骨质疏松合并腰椎管狭窄症３２例（男６例，女２６例），平均年龄６９５岁（５５～８２岁），病程平均２年３个月。结果：术后平均随访２年８个月，优良率９６１％，其中术前临床表现为：间歇性跛行２３例，腰背痛３２例，腰椎活动受限３１例，下肢放散性疼痛３０例，胸腰椎后突增加２１例，胸肋部疼痛１９例。影象学显示骨皮质变薄，骨小梁变细、稀疏，椎间隙变窄和椎体楔形变。     

节段开窗髓核摘除对腰椎稳定性的影响

目的 本研究观察了腰椎椎板节段开窗髓核摘除对腰椎稳定性的影响。方法 ７具新鲜腰骶椎标本头尾端固定,模拟人体行屈曲,侧弯和旋转活动,随后顺序进行Ｌ３－Ｓ１椎板节段开窗及Ｌ４－５,Ｌ５,Ｓ１髓核摘除,对比观察术前和多节段椎板双侧开窗及髓核摘除术后腰椎各节段在三维空间的位移变化,结果 单纯多节段开窗后屈江活动时Ｌ４,５前后水平和轴向位移分别增加１８％和１６％,Ｌ５Ｓ１则分别增加１９％和４５％,椎板开窗加