胸椎间盘突出症的手术治疗

目的：研究分析胸椎间盘突出症患者的手术治疗效果。方法：回顾性分析30例胸椎间盘突出症的临床表现、影像学特征和手术治疗方法。结果：后路全椎板切除减压5例,侧后方或侧前方入路摘除致压物14例,后路全椎板切除、侧后方入路摘除致压物11例。术后随访1－8年,手术优良率达83．4％。结论：胸椎侧后方或侧前方入路摘除椎间盘及后路全椎板切除侧后方入路摘除椎间盘是手术治疗胸椎间盘突出症的有效术式。     

胸椎间盘突出症的诊断和手术治疗

目的：回顾性研究３０例胸椎间盘突出症的临床表现、诊断及手术治疗效果。方法：分别对胸椎间盘突出症的临床表现、影像学特征和手术治疗方法进行描述。结果：后路全椎板切除减压５例,侧后方或侧前方入路摘除致压物１４例,后路全椎板切除侧后方入路摘除致压物１１例,术后随访１～８年,手术优良率达８３．４％,结论：胸椎侧后方或侧前方入路摘除椎间盘及后路全椎板切除侧后方入路摘除椎间盘是手术治疗胸椎间盘突出症的有效术式。     

后路椎间盘切除治疗下胸椎椎间盘突出症

目的 探讨后路椎板切除减压、经关节突关节椎间盘切除、椎间植骨融合并节段性内固定治疗下胸椎椎间盘突出症的疗效.方法 2000年6月至2010年6月,采用后路椎板切除减压、经关节突关节椎间盘切除、椎间植骨融合并节段性内固定治疗下胸椎椎间盘突出症患者36例,男23例,女13例;年龄22～61岁,平均42岁;病程21天至69个月,平均22个月.病变位于T10-11间隙12例,T11-12间隙15例,T12L1间隙9例.所有患者均行X线及MR检查,31例患者行CT检查,其中中央型突出25例,旁中央型7例,外侧型4例.采用Otani等评分系统进行术后疗效评估并计算临床优良率,评价治疗效果.结果 手术时间135～220 min,平均155 min;术中出血量350～800 ml,平均460 ml.所有患者均顺利完成手术,无神经症状加重及意外发生.12例发生脑脊液漏,予硬脊膜连续缝合或补片修补.2例巨大型椎间盘突出患者术后双下肢肌力减退,予激素、脱水、高压氧及营养神经药物治疗后肌力逐渐恢复.术后2周行X线检查示无内固定松动.随访时间14天至48个月,平均4个月.根据Otani等评分标准,优12例,良18例,可5例,差1例;临床优良率83.3%.结论 后路椎板切除减压、经关节突关节椎间盘切除、椎间植骨融合并节段性内固定是治疗下胸椎椎间盘突出症安全有效的术式.     

胸椎间盘突出症的手术治疗

目的 探讨胸腰椎间盘突出症(TDH)的临床表现、诊断及手术治疗方法及效果.方法 经后路手术治疗TDH患者24例,采用后路全椎板切除,经一侧或两侧关节突和下位横突进入切除突出椎间盘,其中15例采用后路椎间植骨融合双侧钉棒系统内固定,9例采用后路椎间植骨融合单侧钉棒系统内固定.结果 随访1～8年,23例脊髓神经功能均有不同程度改善,1例T10～11巨大椎间盘突出者神经功能无改善.1例T8～9椎间盘突出合并后纵韧带骨化者术后症状加重,经对症治疗后1例神经症状加重者术后26个月神经功能恢复至D级.按Otani et al方法评价疗效:优16例,良8例,优良率达91.6%.结论 CT或MRI检查对TDH确诊与定位有重要价值.后路经关节突和下位横突(单或双侧)入路切除胸椎间盘可获得满意疗效.     

Scheuermann病致胸腰段椎间盘突出症的手术治疗

目的 探讨 Scheuermann病引起胸腰段椎间盘突出症的临床特点及手术治疗.方法 手术治疗因Scheuermann病所致胸腰段椎间盘突出症共3例.均采用后路椎管减压椎间盘切除椎弓根钉内固定、椎间植骨融合术.结果 术后1例出现下肢神经症状加重,1例出现脑脊液漏,经相应处理后获得治愈.平均随访20个月,获得较好的植骨融...     

腰椎椎间盘突出症再手术因素及治疗策略

目的探讨腰椎椎间盘突出症再手术的因素,以及手术治疗的方法和疗效。方法回顾分析2007年1月～2010年6月收治的腰椎椎间盘突出症再手术病例共计73例,再手术方式为单侧椎板开窗椎间盘切除术14例,半椎板切除减压椎间盘切除术11例,全椎板切除减压椎间盘切除术6例,后路腰椎椎间盘切除联合椎体间植骨融合术40例,内固定翻修2例。结果本组出现并发症14例,经治疗后好转。获得6～44个月随访,平均21个月。Oswestry功能障碍指数（Oswestry disability index,ODI）：术前（63.26±5.36）%,术后3个月（19.68±8.42）%。视觉模拟量表（visual analog scale,VAS）评分：术前7.26±2.06分,术后3个月3.68±1.22分。ODI及VAS评分均有明显改善,与术前相比差异有统计学意义（P〈0.05）。结论腰椎椎间盘突出症再手术主要因素为术中突出节段定位错误,游离髓核摘除不彻底,遗漏突出间隙的椎间盘,邻近节段退变突出,椎管狭窄减压不充分,腰椎不稳,内固定失败等;再手术时正确选择手术时机和方法仍可以获得较满意的疗效。     

经关节突入路治疗胸椎间盘突出症

目的 探讨经关节突入路治疗胸椎间盘突出症的手术方法及疗效.方法 1994年10月至2009年8月,治疗33例胸椎间盘突出症患者,男27例,女6例;年龄18～72岁,平均41.8岁;病程12天至36个月,其中病程＜1个月者13例;9例因外伤而出现下肢麻木、无力,其余发病无明显诱因,病程缓慢,呈进行性发展.单纯椎间盘突出15例,合并后纵韧带骨化6例,合并黄韧带骨化或肥厚12例.病变共发生在45个椎间盘,其中发生于下胸段(71.11%,32/45)最多,上胸段(17.78%,8/45)次之,中胸段(11.11%,5/45)最少.手术采用经一侧或两侧关节突关节进入切除突出椎间盘和骨化的后纵韧带,对于合并黄韧带骨化或肥厚的患者同时行后路全椎板截骨原位回植术.其中19例采用单侧钉棒固定,14例采用双侧钉棒固定.结果 29例患者获得随访,随访时间12～63个月,平均37个月.疗效评价参照Epstein和Schwall标准,优15例,良10例,改善2例,差2例,优良率86.21%(25/29),总有效率93.10%(27/29).3例出现并发症:其中运动障碍加重2例,经甲基泼尼松龙冲击、脱水剂、神经营养药物及高压氧治疗后1例恢复至术前水平,1例虽有所恢复,但未达到术前水平;内固定断裂1例,术后18个月取出内固定.术后CT及MRI均显示回植椎板融合成形良好,手术减压满意.结论 经关节突入路切除突出的胸椎间盘可获得满意疗效.     

“菱形”截骨切除脊髓前方致压物治疗硬化性胸及胸腰段椎间盘突出症

目的:探讨经后路"菱形"截骨切除脊髓前方致压物治疗硬化性胸及胸腰段椎间盘突出症的临床疗效。方法:2009年8月~2014年7月,共收治26例硬化性胸及胸腰段椎间盘突出症患者,男19例,女7例;年龄平均43.8±23.3岁(18~70岁)。19例为胸椎间盘突出,包括胸椎间盘突出并钙化14例,胸椎后缘骨赘5例;7例为胸腰段椎间盘突出并钙化。术前神经功能Frankel分级:B级3例,C级14例,D级9例。手术均采用经后路"菱形"截骨切除脊髓前方致压物。手术疗效评价参照改良Macnab疗效评定标准及Frankel分级,随访观察治疗效果。结果:手术均顺利完成,术后X线片显示内固定位置良好,CT显示突出物切除彻底。1例患者(T10/11)术后出现症状加重(Frankel分级由D级变为C级),经甲强龙、脱水剂、营养神经药物治疗后恢复至术前水平。随访5~36个月,平均19.8个月。24例患者术后神经功能获不同程度恢复(2例Frankel D级患者无变化)。根据改良Macnab疗效评定标准,本组优15例,良8例,可2例,差1例,优良率88.46%(23/26),总有效率96.15%(25/26)。所有患者均获得骨性融合,无内固定松动断裂等并发症发生。结论:经后路"菱形"截骨切除脊髓前方致压物治疗硬化性胸及胸腰段椎间盘突出症可获得满意疗效。     

椎间盘镜手术治疗腰椎间盘突出症

目的：评价椎间盘镜手术治疗腰椎间盘突出症的临床疗效。方法：腰椎间盘突出症患者15例，男11例，女4例；平均年龄39．8岁。在椎间盘镜下行腰椎间盘髓核切除、椎板减压及神经根管扩大术。术前在X线机下，分别于病变节段上位棘突下缘、上位椎板下缘中点定位，置人内窥镜头。在椎间盘镜配套的监视器下咬除部分椎板下缘及黄韧带，扩大椎板间隙，清除椎间盘髓核组织，扩大神经根管。结果：本组除1例患者因术中硬膜囊破裂改为开放手术，其余14例平均手术出血量60ml，平均手术时问86min。本组平均随访时间13．2个月，按照Nakai评级，优11例，良3例，可1例。结论：椎间盘镜手术治疗腰椎间盘突出症比常规手术方法视野清晰、创伤小、恢复快，基本保持了脊柱后柱完整。     

PCB系统在颈椎间盘突出症手术中的应用

目的：探讨PCB系统在颈椎间盘突出症手术中的应用价值。方法：对12例颈椎间盘突出症患者颈前路椎间盘切除、PCB系统置入融合术，术后进行5－17个月（平均10个月）随访。结果：术后症状消失，神经功能恢复者7例，症状显著缓解，神经功能显著恢复者4例，优良率92％（11／12）。术后6个月椎间植骨融合率100％。钢板和螺丝钉无松动和断裂现象。结论：应用颈前路椎间盘切除、PCB系统置入融合术治疗颈椎间盘突出症可提供术后即刻稳定，恢复椎间隙高度及颈椎生理前凸、植骨融合率高。     

全椎板截骨再植椎管扩大成形术治疗胸椎黄韧带骨化症

目的总结胸椎黄韧带骨化症导致胸椎椎管狭窄的影像学特点，探讨改良椎管减压术的临床疗效。方法胸椎黄韧带骨化症31例，男18例，女13例；年龄26—73岁，平均45．7岁。术前均行MR、CT检查以明确诊断。合并颈椎管狭窄3例、腰椎管狭窄5例，颈胸腰椎管狭窄同时存在者2例；合并胸椎后纵韧带骨化和椎间盘突出症9例。单节段3例，双节段12例，三节段11例，四节段以上5例。局限型6例，连续型17例，跳跃型8例。共94个病变节段，其中上胸段(T1～T4)23个节段、中胸段(T5～T8)19个节段、下胸段(T9-T12)52个节段。手术采用全椎板截骨原位再植椎管扩大成形术。对9例合并胸椎后纵韧带骨化和椎间盘突出者，在后方减压的同时，行切除椎管前方突出椎间盘的环脊髓减压及后路钉棒系统内固定。术后疗效评价参照Epstein标准。结果24例患者随访6—63个月，平均15个月。术后疗效优14例、良7例、可3例，优良率87．5％。1例因术后停用脱水药物过早引起下肢瘫痪症状加重；2例出现下肢静脉血栓；2例硬脊膜撕裂。结论MR结合CT检查是诊断胸椎黄韧带骨化症最有效的手段，全椎板截骨再植椎管扩大成形术安全可靠，疗效满意。     

保留棘突椎板的经关节突入路治疗胸椎椎间盘突出症

目的探讨保留棘突椎板的经关节突入路治疗胸椎椎间盘突出症的手术方法及疗效。方法 2009年10月～2011年8月,采用保留棘突椎板的经关节突入路治疗8例单节段胸椎椎间盘突出症患者,其中男6例,女2例;年龄24～49岁,平均35.4岁;病程1～9个月,5例有外伤史,其余发病无明显诱因。单纯椎间盘突出5例,合并后纵韧带骨化1例,合并椎体后缘骨赘形成2例。病变节段为T8/T91例,T9/T102例,T10/T112例,T11/T121例,T12/L12例。手术保留棘突椎板,采用经双侧关节突入路切除突出椎间盘、骨化的后纵韧带及后缘骨赘。8例均采用双侧相邻节段钉棒固定。结果 8例患者均获得随访,随访时间3～15个月,平均9个月。疗效评价参照Epstein标准,优6例,良1例,差1例,优良率87.5%（7/8）。结论保留棘突椎板的经关节突入路切除突出的胸椎椎间盘可获得满意疗效。     

腰椎手术失败综合征的原因分析及再手术治疗

目的探讨腰椎手术失败综合征的主要原因及再手术治疗效果。方法下腰椎术后综合征患者24例，单侧椎板开窗髓核切除10例，全椎板切除髓核切除14例，其中椎弓根内固定3例，均再次手术。再手术术式包括：半椎板或全椎板减压，髓核切除，椎管神经根管彻底减压，椎弓根内固定，椎间融合或后外侧植骨融合。结果腰椎手术失败综合征原因为同一节段椎间盘突出复发或相邻节段椎间盘退变突出，原手术节段或相邻节段椎管狭窄，手术定位错误，内固定失败。24例获2个月～3年随访，再手术后均获得满意效果。临床改善率为80．2％。优18例，良6例。结论下腰椎手术失败后，积极、合理地再手术治疗，仍能获得满意疗效。     

Results of hemivertebrectomy and fusion for symptomatic thoracic disc herniation

We retrospectively analysed ten consecutive patients (age range 32-77 years) treated surgically from 1994 to 1999 for symptomatic thoracic disc herniation between the 6th and 12th thoracic discs. Clinically, eight patients had varying grades of back pain and eight patients had paraparesis. Radiography showed calcification in 50% of the herniated discs. Two patients had two-level thoracic disc herniation. Hemivertebrectomy followed by discectomy and fusion was carried out in all patients. Instrumentation with cages was performed in eight patients and bone grafting alone in two patients. The average follow-up was 24 months (range 13-36 months). Six patients had an excellent or good outcome, three had a fair outcome and one had a poor outcome. One patient had atelectasis, which recovered within 2 days of surgery. Another patient had developed complete paraplegia, detected at surgery by SSEPs, and underwent resurgery following magnetic resonance (MR) scan with complete corpectomy and instrumented fusion. At 2 years, she had a functional recovery. The patient with poor outcome had undergone a previous discectomy at T9/10. He developed severe back pain and generalised hyper-reflexia following corpectomy and fusion for disc herniation at T10/11. We advocate anterior transthoracic discectomy following partial corpectomy for symptomatic thoracic disc herniation between the 6th and 12th thoracic discs. This procedure offers improved access to the thoracic disc for an instrumented fusion, which is likely to decrease the risk of iatrogenic injury to the spinal cord.     

后路椎间盘镜手术中转传统开窗椎板切除髓核摘除术的原因分析

目的 分析后路椎间盘镜(MED)治疗腰椎间盘突出症术中转传统开窗椎板部分切除髓核摘除术的原因,探讨相应的预防措施.方法 分析应用MED技术治疗300例(342个间隙)患者的临床资料,总结9例中转开窗椎板部分切除髓核摘除术的原因,并提出相应的预防措施.结果 300例患者手术切口均一期愈合.疗效评定:优148例,良130例,中18例,差4例,优良率为92.7%.中转开窗椎板部分切除髓核摘除术9例:3例术中出血多者果断中转而治愈;5例脑脊液漏者经治疗治愈;1例神经根损伤开放探查,为部分马尾损伤,经治疗残留部分感觉减退但无足下垂.结论 硬脊膜损伤、术中出血、神经根损伤是MED治疗腰椎间盘突出症中转传统开窗椎板部分切除髓核摘除术的常见原因;术者丰富的微创经验、合适的病例选择可减少MED治疗腰椎间盘突出症中转开窗椎板部分切除髓核摘除术.     

Analysis of the results of surgery and nucleolysis using papain in 1085 cases of lumbar disk hernias]

1,085 patients have been treated for intervertebral disc herniation with lombo-sciatica: in 751 cases surgical discectomy without laminectomy has been performed with or without microscope; 334 underwent papain nucleolysis. The two clinical groups were separated on clinical and radiographic backgrounds: nucleolysis was performed in patients with no motor disturbance, no stenosis of the lumbar canal, no displaced fragment; the other patients received surgical treatment. The results were evaluated according to MacNab's criteria with a follow-up of 12 to 84 months (mean 17.2 months). The results after surgical treatment were excellent in 53.8% and good in 36.8% of the cases. For papain treatment they were excellent in 32.7% and good in 38.8% of the cases. Papain nucleolysis therefore appears to be an efficient method for the treatment of intervertebral disc herniations associated with lombo-sciatica but, overall, gives poorer results than surgery in spite of a strict selection procedure. In this study, complications due to papain nucleolysis were restricted to chemical spondylodiscitis (5 cases) and to 2 benign allergic syndromes. Statistical analysis of all the cases and multifactorial correlation research pointed out the importance of "workmen's compensation" as prognostic factor. Since this study, 90% of the patients presenting with disc herniation associated with lombo-sciatica recalcitrant to medical treatment undergo surgical discectomy; papain nucleolysis is reserved for sub-ligamentary and non-displaced forms without stenosis of the lumbar canal and represent 10% of our current population.     

脊柱后路显微椎间盘镜治疗腰椎间盘突出症

目的 :通过后路显微内窥镜椎间盘摘除术 (MED)的临床应用 ,探讨其技术要点和临床效果。方法 :对 116例 (14 3个间隙 )腰椎间盘突出症 (LDH)患者施行后路显微内窥镜椎间盘摘除术 (MED) ,对其疗效进行回顾性分析。结果 :本组病人均在术后 7d内出院 ;全组病人均获得随访 ,平均随访时间 5 5个月 ,术后按Macnnab标准行功能评级 :优 68例 ,良 3 9例 ,可 9例 ,优良率 92 2 %。结论 :后路显微内窥镜椎间盘摘除术具有手术创伤小、脊柱稳定性影响小、患者术后恢复快且疗效肯定的特点 ,是脊柱微创外科的发展方向之一。     

Outpatient laminotomy and discectomy.

This is a prospective study of 61 consecutive patients undergoing lumbar laminotomy and discectomy on an outpatient basis. The purpose of this study was to report on the feasibility of performing lumbar laminotomy and discectomy as an outpatient procedure and to assess perioperative complications, patient satisfaction, cost, and clinical results. Conventional lumbar laminotomy and discectomy traditionally requires a 1-3-day hospital stay. Recent advances in anesthesia and surgical techniques, as well as observation of patient progress after this procedure, has led the authors to believe that that this procedure may be performed on an outpatient basis without compromising patient satisfaction, outcome, or complications. Sixty-one consecutive patients underwent surgery for herniated nucleus pulposus in the lumbar spine. The procedure was performed under loupe magnification without the use of a microscope. Clinical outcome and patient satisfaction were assessed at an average follow-up of 12.5 months. The results showed 62% excellent, 31% good, 7% fair, and there were no reports of a poor outcome. During the time of the study, four patients (7%) were admitted to the hospital after the procedure for reasons of pain control, inability to void, or lack of caregiver at home. Overall cost savings were reflected in the cost of inpatient stay when compared to a representative group of inpatients. Laminotomy and discectomy for a hemiated nucleus pulposus has 93% good or excellent results as shown by this study and previous studies. Laminotomy and discectomy, which remains the gold-standard procedure for herniated disc surgery, can be performed safely and effectively as an outpatient procedure in the majority of patients.