外伤性颈椎间盘突出症的手术治疗

2000年2月至2007年7月本院收治22例颈郜损伤致急性颈椎间盘突出症患者，均采取手术治疗，取得满意疗效。现报道如下。     

急性颈椎间盘突出症并颈髓损伤的早期手术治疗

随着MRI的广泛应用，急性颈椎间盘突出症并颈髓损伤的临床报告日趋增多，手术治疗主要采用颈前路减压融合固定技术，本院自2000年6月以来采用颈前路减压、Cage和带锁钢板内固定术治疗急性颈椎间盘突出症并颈髓损伤38例，效果满意，现报告如下。     

经皮穿刺颈椎间盘摘除术患者的护理

颈椎间盘突出症是由于颈部过度活动或椎间盘退行性改变导致纤维环破裂和盘内压升高,引起髓核突出,压迫颈神经根及脊髓,出现肩、颈、上肢痛和四肢感觉运动障碍,严重影响患者的工作和生活,甚至瘫痪.以往以保守治疗和手术为主要治疗手段[1].经皮穿刺椎间盘摘除术与传统手术比较具有简易、微创、疗效好、恢复快的特点,近年被广泛应用于腰椎间盘突出症的治疗(PLD).我院于1993年10月至1997年11月,采用经皮穿刺摘除颈椎间盘(PCD)术治疗99例颈椎间盘突出症,并加强护理,效果显著.报告如下.     

颈前路椎间盘摘除术在急性颈椎间盘突出症中的应用(附36例报告)

本文报告应用颈前路椎间盘摘除术治疗急性颈椎间盘突出症36例,获得满意疗效.文中介绍了颈前路椎间盘摘除术的具体方法和注意事项.作者认为,本手术方法具有创伤小,安全性大,操作易行,对颈髓和神经根减压较彻底等优点,是治疗急性椎间盘突出症的可靠方法.     

颈前路椎间盘摘除术在急性颈椎间盘突出症中的应用：附36…

本文报告应用颈前路椎间盘摘除术治疗急性颈椎间盘突出症３６例，获得满意疗效。文中介绍了颈前路椎间盘摘除术的具体方法和注意事项。作者认为，本手术方法具有创伤小，安全性大，操作易行，对颈髓和神经根减压较彻底等优点，是治疗急性椎间盘突出症的可靠方法。     

接触式激光刀治疗颈腰椎间盘突出症

目的探讨接触式激光刀治疗椎间盘突出症的效果。方法自2003年5月至2007年6月选择有颈肩或腰腿疼痛,影像学检查证实有椎间盘膨出或突出,不伴有骨性椎管狭窄的病人,应用美国进口SLT-Touch接触式激光刀,采用经皮激光椎间盘减压术治疗椎间盘突出症235例。颈椎间盘突出症81例,腰椎间盘突出症154例,共287个椎间盘。结果随访4个月-5年,采用中华骨科学会脊柱学组腰背痛手术评定标准评价,优185例,良39例,差11例,优良率95.3%。结论接触式激光刀能量释放精确,对周围组织热损伤小,经皮激光椎间盘减压术是治疗椎间盘突出症的微创、有效方法。     

急性颈椎间盘突出症并颈髓损伤的早期手术治疗

随着MRI的广泛应用 ,急性颈椎间盘突出症并颈髓损伤的临床报告日趋增多 ,手术治疗主要采用颈前路减压融合固定技术 ,本院自 2 0 0 0年 6月以来采用颈前路减压、Cage和带锁钢板内固定术治疗急性颈椎间盘突出症并颈髓损伤 38例 ,效果满意 ,现报告如下。1　临床资料1 1　一般资料　男 2 6例 ,女 1 2例 ,年龄 2 8～ 6 7岁 ,平均4 4岁。大多数起病较急 ,有不同程度的颈部及头部外伤史 ,神经损伤按Frankel脊髓损伤分级法分类 :A级 1 1例 ,B级1 7例 ,C级 7例 ,D级 3例。就诊时间 :1 1例在伤后当天入院 ,1 5例在伤后 3d内入院 ,8例伤后 1周入院…     

等离子刀联合胶原酶治疗颈椎间盘突出症

目的 探讨等离子刀联合胶原酶治疗颈椎间盘突出症的临床疗效。方法 对53例颈椎间盘突出症采用等离子刀汽化融切术和椎间盘内胶原酶注射治疗。结果 本组经1～12个月随访，优23例，良26例，满意4例，优良率92．5％。结论 等离子刀联合胶原酶治疗颈椎间盘突出症疗效确切，具有手术操作简单、安全、损伤小、术后恢复快等优点。     

经皮穿刺椎间盘摘除术患者的护理

颈椎间盘突出症是由于颈部过度活动或椎间盘退行性改变导致纤维环破裂和盘内压升高,引起髓核突出,压迫颈神经根及脊髓,出现肩、颈、上肢痛和四肢感觉运动障碍,严重影响患者的工作和生活,甚至瘫痪.以往以保守治疗和手术为主要治疗手段[1].经皮穿刺椎间盘摘除术与传统手术比较具有简易、微创、疗效好、恢复快的特点,近年被广泛应用于腰椎间盘突出症的治疗(PLD).我院于1993年10月至1997年11月,采用经皮穿刺摘除颈椎间盘(PCD)术治疗99例颈椎间盘突出症,并加强护理,效果显著.报告如下.     

等离子髓核成形术两点消融法在颈椎间盘突出症中的应用

目的 回顾分析等离子髓核成形术两点消融法治疗颈椎间盘突出症的临床疗效.方法 应用等离子髓核成形术两点消融法对87例192个颈椎间盘进行手术治疗.结果 获平均6个月的随访,术后1周及6个月的平均症状缓解率分别为76.9%和73.1%.主观满意度分别为92.0%和89.7%.结论 经皮等离子髓核成形术两点消融法能有效地缓解颈椎间盘突出症的症状.具有操作简便、安全、损伤少等优点,对轻中度颈椎间盘突出症是一个较好的治疗选择.     

Anterior cervical foramenotomy for cervical radiculopathy

Anterior cervical discectomy (ACD) is standard practice for cervical radiculopathy. Irrespective of the precise method used, it involves more or less complete disc removal with resultant anatomical and biomechanical derangements, and frequently the insertion of a bone or prosthetic graft. Anterior cervical foramenotomy is an alternative procedure that allows effective anterior decompression of the nerve root and lateral spinal cord, whilst conserving the native disc, preserving normal anatomy and movement, and protecting against later degeneration at adjacent spaces as far as possible. The aim of the study was to determine the safety and efficacy of anterior cervical foramenotomy in the treatment of cervical radiculopathy and took the form of a prospective study of 21 cases under the care of a single surgeon. All patients had a single level or two level anterior cervical foramenotomy. All had pre- and postoperative visual analogue scores for arm and neck pain, arm strength, sensation and overall use. A comparison between patients' perceptions and surgeon's observations was also made. Patients were followed up for between 10 and 36 months. Sixty-eight per cent completed full pre- and postoperative assessments. Twenty-eight per cent of the responders had complete arm pain resolution. There were statistically significant reductions in arm and neck pain, and overall disability. The surgeon's impression of improvement paralleled that of the patients. There was one complication with discitis. Anterior cervical foramenotomy is a safe and effective treatment for cervical radiculopathy caused by posterolateral cervical disc prolapse or uncovertebral osteophyte, and might also reduce adjacent segment degeneration.     

Alternating cervical laminoplasty for cervical spondylotic myelopathy

We present a novel method of performing an 'open-door' cervical laminoplasty. The complete laminotomy is sited on alternate sides at successive levels, thereby allowing the posterior arch to be elevated to alternate sides. Foraminotomies can be carried out on either side to relieve root compression. The midline structures are preserved. We undertook this procedure in 23 elderly patients with a spondylotic myelopathy. Each was assessed clinically and radiologically before and after their operation. Follow-up was for a minimum of three years (mean 4.5 years; 3 to 7). Using the modified Japanese Orthopaedic Association scoring system, the mean pre-operative score was 8.1 (6 to 10), which improved post-operatively to a mean of 12.7 (11 to 14). The mean percentage improvement was 61% (50% to 85.7%) after three years. The canal/vertebral body ratio improved from a mean of 0.65 (0.33 to 0.73) pre-operatively to 0.94 (0.5 to 1.07) postoperatively. Alternating cervical laminoplasty can be performed safely in elderly patients with minimal morbidity and good results.     

微创前路经上位椎体椎间孔减压术治疗神经根型颈椎病

【摘要】 目的：探讨微创前路经上位椎体椎间孔减压术治疗神经根型颈椎病的有效性。方法：2008年7月~2010年7月12例单侧神经根型颈椎病患者在延边大学医院接受微创前路经上位椎体椎间孔减压术。其中男7例,女5例,年龄为35~68岁,平均49岁。椎间孔狭窄部位：C5/6 4例,C6/7 5例,C7/T1 3例。软性髓核突出3例,钩椎关节骨质增生7例,突出的髓核钙化2例。均行前路手术,术中采用脊柱手术专用显微镜,在病变上位椎体确定钻孔起始部位,利用高速钻石气钻磨出一约6mm直径的通路达到病变区域,减压椎间孔。观察术前及末次随访时上肢放射性疼痛的VAS评分、颈椎功能障碍指数（NDI）及病变水平椎间盘高度。结果：手术时间为56~110min,平均86±6min;术中失血量为40~120ml,平均92±8ml。无椎动脉损伤、贺纳氏综合征、喉返神经损伤等并发症。术后随访时间为12~23个月,平均15.8±1.3个月。术前上肢疼痛VAS评分为8.5±0.5分（7~10分）,末次随访时为1.4±0.2分（0~3分）,两者比较有显著性差异（P<0.05）;术前NDI为26.4±1.3分（22~31分）,末次随访时为4.2±0.6分（3~8分）,两者比较有显著性差异（P<0.05）,改善率为84.1%;术前病变水平椎间盘高度为5.4±0.7mm（4.2~6.1mm）,末次随访时为4.9±0.7mm（3.6~5.8mm）,两者比较无显著性差异（P>0.05）。术后满意度为100%。结论：微创前路经上位椎体椎间孔减压术可减少对椎间盘的损伤,是治疗单侧神经根型颈椎病的有效手术方法。     

Posterior cervical laminoplasty formultilevel cervical spine stenosis

Cervical laminoplasty for treating multilevel spinal stenosis appears to be a good surgical alternative to the more traditional laminectomy or anterior decompression and fusion. This procedure avoids the morbidity associated with extensive anterior procedures and also appears not to be associated with late kyphosis, which can be seen in patients after a laminectomy. This review outlines the rationale, indications, contraindications, and early clinical results for patients undergoing a posterior laminoplasty.     

Anterior cervical microforaminotomy for cervical radiculopathy--results and review

Analysis of anterior cervical microforaminotomy performed at the North Staffordshire University Hospital along with a review of literature of this minimally invasive procedure is presented. METHODS: A retrospective-prospective study was performed on 34 patients (24 males, 10 females) with cervical disc disease who had been surgically treated with anterior cervical microforaminotomy between 1999 and 2005. Age ranged from 37 to 75. MRI findings were disc prolapse in 28 and additional osteophytes in six. Microforaminotomy was performed according to the published technique. RESULTS: Single level operations were performed in 22 patients (21 unilateral, 1 bilateral) and multi-level operations were performed in 12 patients (7 unilateral and 5 bilateral). The short-term outcomes were excellent in 65% (i.e., complete resolution of all symptoms), good in 29% (relief of radiculopathy but some non-radicular discomfort persists), and fair in 6% (mild residual radiculopathy with or without non-radicular symptoms). Postoperative complications include one patient with partial C6 root damage, which was identified intraoperatively, but had excellent results at 2 months post operation. Long-term follow-up (using the cervical spine research society questionnaire) ranged from 2-48 months. The average pain score, neurological outcome and functional outcome improved after this operation. RE-OPERATION: One patient, who had 2 level bilateral surgeries, needed discectomies with fusion for new onset myelopathy 18 months later. CONCLUSION: Appropriate patient selection is cardinal in achieving good outcome in anterior microforaminotomy.     

Postoperative instability of cervical OPLL and cervical radiculomyelopathy

The presence of cervical spine instability with respect to preoperative and postoperative changes in angular, horizontal, and rotational displacement of the vertebral body were studied. With the anterior approach, the instability in the remaining unfused segments, and their relation to the kyphotic or lordotic fused segment were studied. With the posterior approach, postoperative ROM (range of motion) could be better maintained, and horizontal displacement was improved in more cases by laminoplasty compared with laminectomy. With the anterior approach, the compensatory function for the loss of motion of the segments resulting from fusion was most remarkable at the levels of C2-3 and C6-7. In the alignment of the anterior fused segments, it appears important that the physiologic lordotic position be maintained.     

Percutaneous cervical nucleoplasty and percutaneous cervical discectomy treatments of the contained cervical disc herniation

Background  

There were no studies in literature to compare the clinical outcomes of percutaneous nucleoplasty (PCN) and percutaneous cervical discectomy (PCD) in contained cervical disc herniation.     

前路颈椎椎间盘切除融合术与动态装置植入术治疗单节段颈椎椎间盘突出症

目的 对比前路颈椎椎间盘切除融合术(ACDF)与颈椎前路动态装置植入术(DCI)对单节段颈椎椎间盘突出症(CDH)患者颈椎活动度(ROM)及术后颈椎曲度的影响.方法 回顾性分析2018年6月—2019年9月海军军医大学长征医院收治的78例单节段CDH患者临床资料,其中42例采用ACDF治疗(ACDF组),36例采用DC...     

颈椎不稳在交感型颈椎病发病中的作用

目的：研究交感型颈椎病的病理因素及治疗方法。方法：回顾分析了1988-2000年收治的20例手术治疗的交感型颈椎病患者。根据术前及术后颈椎伸屈侧位X光片判断有无颈椎不稳。结果：20例患者术前均有颈椎不稳,颈椎不稳主要发生在C3-C4和C4-C5,颈椎高位硬膜外封闭对大部分患者有短期效果。每例患者均于不稳节段行颈前路融合术,手术有效率为90％。结论：颈椎不稳是导致交感型颈椎病发病的重要因素;颈椎高位硬膜外封闭可有短期疗效因此具有重要的诊断价值;颈椎前路植骨融合术是治疗交感型颈椎病的有效方法。