射频消融髓核成形术治疗椎间盘源性腰痛疗效分析

目的 探讨经皮射频消融髓核成形术治疗椎间盘源性腰痛的疗效和安全性.方法 对45例椎间盘源性腰痛患者作射频消融髓核成形术治疗.结果 术后平均随访10.5个月,术前腰痛VAS评分平均为(7.5±0.45)分,术后1周、1个月和最后一次随访分别为(3.6±0.23)分、(3.1±0.55)分和(3.3±0.34)分.包容性腰椎间盘突出症的患者术后下肢放射痛均有不同程度的减轻,无相关并发症.结论 对于椎间盘源性腰痛,射频消融髓核成形术是一种安全和有效的微创手术;但对于神经根性疼痛的缓解效果不佳.     

经皮椎间孔镜微创手术治疗腰椎间盘突出症的疗效

目的探讨经皮椎间孔镜微创手术治疗腰椎间盘突出症的临床疗效。方法经皮椎间孔镜微创手术治疗非手术治疗无效的62例腰椎间盘突出症患者,采用疼痛VAS评分、ODI和改良MacNab标准评价临床疗效。结果患者均获得随访,时间6~12(7.8±3.4)个月。无硬膜破裂、神经根损伤等并发症发生。术后1 d和术后1、3、6个月腰腿痛VAS评分、ODI较术前均明显降低(P<0.01)。末次随访时改良MacNab标准评价疗效优良率为91.93%(57/62)。结论经皮椎间孔镜微创手术治疗腰椎间盘突出症创伤小,并发症少,术后恢复快,近期疗效可靠。     

微创介入术联合温控电热疗法治疗腰椎间盘突出症的护理

目的 探讨微创介入术联合温控电热疗法治疗腰椎间盘突出症患者的护理.方法 对50例腰椎间盘突出症患者采用经皮穿刺腰椎间盘切吸术联合椎间盘内温控电热治疗术;术前加强心理护理、体位护理,术后加强并发症观察及护理、康复锻炼指导.结果 出院时显效33例(66.0%),有效10例(20.0%),总有效率86.0%;随访3个月时显效41例(82.0%),有效9例(18.0%),总有效率100%,均无复发.结论 经皮穿刺腰椎间盘切吸术联合椎间盘内温控电热治疗术治疗腰椎间盘突出症疗效显著,为患者实施全面的整体护理、健康指导及早期康复锻炼,可促进患者早日康复.     

后路微创治疗腰椎间盘突出症43例

目的报道后路微创治疗腰椎间盘突出症的临床效果。方法总结后路微创治疗腰椎间盘突出症的43例疗效，将腰椎间盘突出分为膨出型及突出型两类，所有病例均经CT和（或）MRI检查确诊。结果治疗43例，7例失访，其余36例，随访1—12个月，下肢放射痛症状缓解率95％，腰背部疼痛症状缓解率54％，总有效率81．4％，术后无感染及其他并发症发生。结论后路微创治疗腰椎间盘突出症临床疗效确切，关键在于恰当的病例选择和正确的术中操作。     

微创小切口潜行神经通道扩大技术在腰椎间盘突出症手术治疗中的应用

目的探讨应用微创小切口潜行神经通道扩大技术行腰椎间盘突出症髓核摘除、神经通道松解的手术方法及疗效。方法小切口组30例,采用微创小切口潜行神经通道扩大技术行经后路髓核摘除;对照组20例,行传统后路手术,两组均为单间隙腰椎间盘突出症病例,对其临床资料及随访结果进行病例对照研究。结果小切口组在出血量,手术时间、离床时间方面均优于对照组（P〈0.05）。两组均未出现严重并发症。均获随访,平均7.2（0.5-12）年。下腰椎术后疗效评定：小切口组优27例,良2例,可1例,优良率96.7%,对照组优16例,良2例,可2例,优率良90.0%,两组比较无差异（P〉0.05）。结论应用微创小切口潜行神经通道扩大技术治疗腰椎间盘突出症,手术操作简单、安全,可以在微创的前提下获得与传统手术相同的疗效,且并发症少,值得推广应用。     

TESSYS技术治疗单纯腰椎间盘突出的疗效及并发症

目的探讨TESSYS技术治疗腰椎间盘突出的临床疗效及并发症。方法采用TESSYS技术治疗48例腰椎间盘突出患者。术中仅行单纯髓核摘除。记录手术时间、术中出血量及住院时间。应用腰腿痛VAS评分评价术后疼痛缓解情况,ODI评价腰椎功能改善情况,改良Mac Nab标准评价临床疗效。结果手术时间为45～115(59±25)min,术中出血量为26～100(49±21)ml,住院时间为7～18(14±3)d。术后患者均感觉腿部症状明显缓解。患者均获得随访,时间为24～37(29±6.2)个月。VAS评分、ODI:出院时较术前显著降低(P0.05),术后2年较出院时进一步降低,但差异无统计学意义(P0.05)。末次随访时根据Mac Nab标准评估优良率为91.7%。2例术中出血较多,2例术后发生浅表感染,1例1个月后症状复发,无其他严重并发症发生。结论 TESSYS治疗腰椎间盘突出症疗效显著,具有创伤小、恢复快、保持腰椎结构稳定和并发症少的特点。     

经皮穿刺髓核成形术治疗腰椎间盘突出症初步临床报道

目的　寻求一种简单、安全、有效、微创的椎间盘突出症治疗方法。方法　对 1 6例腰椎间盘突出症采用经皮穿刺髓核成形术 (Nucleoplasty)治疗 ,并对其疗效进行观察分析。 结果　全部患者经二周至一个月短期随访 ,症状均有不同程度改善 ,疗效优良率为 93 8% ,有效率为 1 0 0 %。未发现明显并发症。结论　髓核成形术是一种先进、安全、有效的椎间盘突出微创手术 ,具有操作简单、安全、微创、疗效佳、恢复快、无需住院等优点。     

CT结合椎间盘造影(CTD)及其临床意义

目的明确CTD的适应证及在椎间盘源性疾病诊治的临床意义。方法对已作CT或和MR、椎管造影等检查未能明确诊断的腰椎间盘突出症、疑为椎间盘源性下腰痛及椎间盘突出症诊断明确为选择介入方法的患者作CTD检查,并根据检查结果选择不同的介入治疗方法治疗。结果术后随访6月～5年,椎间盘突出症介入的优良率为91.3%;椎间盘源性下腰痛的优良率为75%。结论CTD对椎间盘源性腰痛的诊断、腰椎间盘突出症的诊断及介入治疗方法的选择具有重要的临床意义。     

后路显微椎间盘镜治疗腰椎间盘突出症的疗效评估

目的 报道后路椎问盘镜微创术(MED)治疗腰椎间盘突出症的中期疗效. 方法 总结分析开展MED治疗的37例腰椎间盘突出症临床资料,早期于术后5.5个月、中期于术后66个月对全部病例进行随访.按Nakai标准评定疗效,分优、良、可、差4级,比较全部病例的早期及中期随访时的疗效优良率.结果 早期随访疗效:优21例,良14例(优良率94.6%);中期随访疗效:优18例,良15例(优良率89.2%). 结论 后路椎间盘镜微创术治疗腰椎间盘突出症具有良好的早、中期疗效.     

CT定位内镜椎间盘切除治疗腰椎间盘源性马尾综合征

[目的]探讨CT定位内镜椎间盘切除治疗腰椎间盘源性马尾综合征(cauda equina syndrome, CES)的可行性与疗效。[方法] 2011年4月—2019年12月本院采用CT定位内镜椎间盘切除治疗腰椎间盘源性CES患者26例,记录分析围手术期、随访与影像资料。[结果] 26例均顺利完成手术,术中无硬膜撕裂、神经根损伤等严重并发症发生,所有患者均随访12个月以上,随时间推移患者VAS评分、ODI评分显著下降(P0.05),而JOA评分显著增加(P0.05)。末次随访时,根据Nakano标准评定疗效,优10例,良9例,优良率为73.08%。影像方面,术后椎管面积较术前明显增大,而突出物占比明显减小(P0.05)。[结论] CT定位内镜椎间盘切除治疗腰椎间盘源性CES精准微创、减压彻底,可取得满意疗效。     

两种脊柱融合术治疗腰椎管狭窄症合并轻度腰椎滑脱的临床疗效比较

目的比较两种脊柱融合术治疗腰椎管狭窄症伴轻度腰椎滑脱的临床疗效。方法将1998年4月至2003年4月收治的45例患者分为A、B两组。分别行椎管减压 SOCON复位 横突间植骨术(A组),在A组基础上加用椎间融合器(Cage)固定(B组)。A组24例,平均54岁,其中退变型17例,峡部型7例。B组21例,平均53岁,其中退变型16例,峡部型5例。两组滑脱主要部位为L4-5和(或)L5～S1,滑脱度为Ⅰ至Ⅱ度,术前均行脊髓造影或CTM检查,证实有侧隐窝狭窄和(或)中央椎管狭窄。结果随访时间1～6年,A组临床疗效满意率91．7％(22／24);完全复位率为91．7％(22／24)。B组临床疗效满意率90．5％(19／21);完全复位率为95．2％(20／21)。A组手术时间、术中出血、输血量、手术并发症情况优于B组,两组滑脱复位率及随访后最终临床疗效无显著差异,B组滑脱角及椎间盘指数恢复优于A组。结论彻底减压、后外侧融合加椎弓根内固定是首选手术方案,应强调Cage适应证。     

单侧双通道内镜下经对侧入路治疗腰椎间孔狭窄症的临床疗效

目的: 评估单侧双通道内镜技术经对侧入路治疗腰椎椎间孔狭窄症的可行性及影像学结果。方法: 回顾性分析2021年1月至2022年7月收治的33例接受单侧双通道内镜技术治疗腰椎间孔狭窄症患者的临床资料,男17例,女16例;年龄34~72(56.00±7.89)岁;记录手术时间、围手术期并发症;采用疼痛视觉模拟评分法(visual analogue scale,VAS)评估患者腰痛和下肢疼痛程度,Oswestry功能障碍指数(Oswestry disability index,ODI)评估腰椎功能状况;末次随访时采用改良Macnab评分标准评价临床疗效。结果: 所有患者顺利完成手术,手术时间47~65(56.10±5.19) min;术后随访12~18(14.9±2.3)个月。术前腰腿痛VAS[(7.273±1.442)分,(7.697±1.447)分],ODI(69.182±9.740) %;术后腰腿痛VAS[(3.394±0.966分,(2.818±0.727)分],ODI (17.30±4.78) %;末次随访腰腿痛VAS[(2.788±0.650)分,(2.394±0.704)分],ODI (14.33±3.50) %。术后腰腿痛VAS及ODI与术前比较,差异均有统计学意义(P<0.05)。1例术后出现脑脊液漏,经治疗后状况良好。末次随访时,根据改良Macnab评定标准,优24例,良5例,可2例,差2例。结论: 单侧双通道内镜下经对侧入路治疗腰椎间孔狭窄症,操作安全、高效,并发症少,术后恢复快,临床疗效满意,在随访期间,患者未出现医源性腰椎不稳定。     

Failure of external spinal skeletal fixation to improve predictability of lumbar arthrodesis.

BACKGROUND: Whether lumbar arthrodesis can relieve isolated low-back pain in the absence of focal neurological findings or instability is unclear. The results of published studies are also inconsistent with regard to whether temporary back-pain relief with external spinal skeletal fixation can predict lasting back-pain relief after arthrodesis. This report presents the results, with regard to clinical benefit and complications, of more than 100 external spinal skeletal fixation procedures undertaken as a prelude to lumbar arthrodesis. METHODS: The records of all patients who underwent external spinal skeletal fixation between 1989 and 1999 were reviewed with attention to perioperative complications, pain relief from the test procedure, the clinical benefit from a subsequent arthrodesis, and the functional status after the arthrodesis. Analyzed data included the frequency of neurological complications and infections and the benefit (Prolo score) after staged spinal arthrodesis in patients who underwent arthrodesis after temporarily experiencing pain relief with the test procedure. RESULTS: A total of 103 external spinal skeletal fixation procedures were undertaken. Neurological complications occurred in two procedures (2%); one resulted in permanent sciatica. Infections occurred in five patients (5%). Sixty patients experienced pain relief during the external fixation test, but only twenty-seven of forty-nine patients who went on to have an arthrodesis and had sufficient follow-up reported that they were doing well at a minimum of one year later. In no case did the external spinal skeletal fixation procedure cause a permanent increase in low-back pain. CONCLUSIONS: On the basis of this analysis, external spinal skeletal fixation should not be used as a predictor of pain relief after lumbar arthrodesis.     

Reconstruction of the lumbar spine using AO DCP plate internal fixation

Augmentation of lumbar spine fusion with internal fixation using pedicle screw systems has gained wide currency because it offers rigid stabilization to foster fusion healing. The AO DCP plate has been employed in Europe as a spinal implant with pedicle fixation using 6.5 mm, full-threaded cancellous bone screws with success. This report details the experience of using this device for lumbar spine fusion in a series of 46 North American patients with a mean follow-up of 1.25 years (range 1-2.5 years). Thirty-one patients had had prior lumbar spine surgery with poor outcomes, and 15 had had no prior surgery. All were treated surgically for lumbar degenerative disease with canal decompression, internal fixation with AO plates, and fusion with autologous bone grafting posterolaterally. Complications included two early and one delayed wound infection; five cases of screw loosening; three cases of screw breakage; and three cases of screw impingement upon a nerve. Results of surgery in 17 patients with failed interbody fusion included good to excellent pain relief in 59%, and solid fusion in 76%. In 14 patients with failed posterior surgery the good to excellent pain relief rate was 79%, and the fusion rate was 86%. In 15 patients undergoing primary surgery there was 89% good to excellent pain relief and a solid fusion rate of 87%. The benefits accruing from augmentation of the fusion with internal fixation using AO DCP plates are positive and justify its continued use. Complications encountered in the early experience have been significantly reduced in subsequent series, indicating the existence of a "learning curve" effect which would mandate specific training of spinal surgeons in the technique.     

Balloon kyphoplasty: an experience of 38 patients with painful osteoporotic vertebral compressive fractures

Objective: To evaluate the efficacy and safety of percutaneous balloon kyphoplasty as a new therapy for patients with painful osteoporotic vertebral compressive fractures of the lumbar and thoracic spine. Methods: A retrospective analysis was conducted in 38 consecutive patients (28 females, 10 males), whose ages ranged from 56 to 82 years (mean age 72 years). The symptom- and sign-positive spinal segment was identified by MRI. The time between onset of symptoms and surgical intervention ranged from 2 days to 1 year. 62 segments (36 thoracic, 26 lumbar) were treated in this cohort. The pain score estimated by Visual Analog Scale and activity degree were assessed immediately after operation and at 1-, 6-, and 12-month postoperative follow-up. Preoperative and postoperative anterior, midline vertebral heights in fractured vertebrae were measured on lateral radiographs to evaluate the effect of the procedure. Results: The method achieved a swift pain relief associated with an evidently increased weight-bearing ability. The pain score was reduced from 8.2 to 2.4 points. The anterior and midline vertebral heights in 62 fractured vertebral bodies increased up to 82.76%±26.84%, 88.82%±21.75% and the wedge decreased from 15 to 8 degrees. This effect persisted at least over a period of two years. The procedure did not induce narrowing of the spinal canal and no severe complications occurred. Conclusions: Balloon kyphoplasty can result in immediate clinical improvement of mobility and pain relief, increase vertebral body height, and quickly return patient's activity. The short-term results are approved excellent, and the long-term results need further judgment.     

Balloon kyphoplasty： an experience of 38 patients wit painful osteoporotic vertebral compressive fractures

OBJECTIVE: To evaluate the efficacy and safety of percutaneous balloon kyphoplasty as a new therapy for patients with painful osteoporotic vertebral compressive fractures of the lumbar and thoracic spine. METHODS:A retrospective analysis was conducted in 38 consecutive patients (28 females, 10 males), whose ages ranged from 56 to 82 years (mean age 72 years). The symptom- and sign-positive spinal segment was identified by MRI. The time between onset of symptoms and surgical intervention ranged from 2 days to 1 year. 62 segments (36 thoracic, 26 lumbar) were treated in this cohort. The pain score estimated by Visual Analog Scale and activity degree were assessed immediately after operation and at 1-, 6-, and 12-month postoperative follow-up. Preoperative and postoperative anterior, midline vertebral heights in fractured vertebrae were measured on lateral radiographs to evaluate the effect of the procedure. RESULTS: The method achieved a swift pain relief associated with an evidently increased weight-bearing ability. The pain score was reduced from 8.2 to 2.4 points. The anterior and midline vertebral heights in 62 fractured vertebral bodies increased up to 82.76%+/-26.84%, 88.82%+/-21.75% and the wedge decreased from 15 to 8 degrees. This effect persisted at least over a period of two years. The procedure did not induce narrowing of the spinal canal and no severe complications occurred. CONCLUSIONS: Balloon kyphoplasty can result in immediate clinical improvement of mobility and pain relief, increase vertebral body height, and quickly return patient's activity. The short-term results are approved excellent, and the long-term results need further judgment.     

棘突间移植物治疗腰椎关节突关节退变的初期结果

目的 评价棘突间移植物-DIAM(device for intervertebral assisted motion)对腰椎关节突关节退变的治疗效果及相关术中、术后并发症.方法 对2005年8月至2006年4月接受DIAM移植的22例患者进行回顾性分析.女14例,男8例;平均年龄38.5(24～59)岁.单节段14例,双节段8例;单发腰椎关节突关节退变诱发腰痛16例(其中3例为腰椎人工间盘置换术后残留腰痛),腰椎间盘突出3例,腰椎管狭窄伴间歇性跛行2例,腰椎间盘后路摘除术后1例.结果手术时间为25 min(单节段)和35 min(双节段).术后所有患者随访16～28个月,平均17个月.术后影像学检查显示移植物无明显迁移.正位X线片显示移植物撑开了棘突间间隙,侧位X线片显示神经根管高度、椎间隙后高度术前及术后66周的比较差异有统计学意义(P<0.01).术后症状改善程度采用Odom评估法,优7例,良10例,可1例,差4例;优良率77.3%.视觉模拟评分由术前平均(7.09±0.92)分改善至术后66周平均(3.23±1.82)分,差异有统计学意义(P<0.01).随访期间未发生症状加重、移植物松脱及术后翻修.结论 应用棘突间移植物技术治疗单发的腰椎关节突关节退变,保留了腰椎后柱结构稳定性,操作简单.通过棘突间撑开作用降低了关节突关节的应力,增加了神经根管高度,恢复了腰椎后柱高度.     

通用型脊柱椎弓根内固定系统治疗腰椎滑脱的临床研究

目的 观察自行研制的通用型脊柱内固定系统用于退行性腰椎滑脱患者手术治疗的疗效。方法 16例退行性腰椎滑脱合并椎管狭窄的患者,均接受了通用型脊柱内固定系统手术治疗。其中男10例,女6例。平均年龄58．5岁(42～72岁)。术前Ⅰ度滑脱10例,Ⅱ度滑脱6例,术后定期随访记录患者的症状改善、滑脱复位程度及并发症等情况。结果 16例患者术后平均随访21．2个月(18～24个月),术后即刻及末次随访时X线摄片显示滑脱腰椎均完全复位,于末次随访时15例患者术前临床症状均消失,滑脱复位满意且无丢失,后外侧植骨融合术后及随访过程中未发现与植入物或手术相关的并发症。结论 初步结果显示,通用型脊柱内固定系统用于腰椎滑脱的手术治疗可获得满意的滑椎复位效果和良好临床疗效。     

Lumbar disc excision in children and adolescents

STUDY DESIGN: The authors examined a case series of patients under the age of 18 years treated for lumbar intervertebral disc herniation. OBJECTIVES: To evaluate postoperative and long-term results of surgery in patients younger than 18 years. SUMMARY OF BACKGROUND DATA: There are only a few series, with controversial results, available on the surgical treatment of disc herniation in growing patients. METHODS: Between 1975 and 1991, a consecutive series of 129 patients 9-18 years of age (average age, 16.2 years) underwent surgery for lumbar intervertebral disc herniation. Low back pain associated with leg pain was the main clinical symptom in 106 subjects (82%), back pain in 17 (13%), and leg pain in 6 (5%). RESULTS: Short-term results were excellent or good for 123 cases (95%), with complete pain relief in 97 (75%) and moderate but incomplete relief in 26 (20%). A total of 98 (76%) long-term responses obtained at a mean follow-up of 12.4 years revealed excellent outcomes in 40% of the cases, good in 47%, and poor in 13%. Ten patients (10%) underwent reintervention after 9 years on average (2 fusions and 8 re-explorations for herniated disc). CONCLUSIONS: Results have confirmed a tendency for outcomes to deteriorate between the short-term and long-term follow-up in young patients treated by discectomy: this tendency and the rate of reintervention (10%) confirmed the need for long-term follow-up of children and adolescents treated for disc herniation.     

The late results of antero-lateral cordotomy for pain relief

Summary The operation of antero-lateral cordotomy was carried out on 56 patients with intractable pain between 1968 and 1978. The follow-up of these patients was continued for at least three years or until death to determine the late success of this procedure. Of the 33 patients who underwent surgery for malignant pain 95% of survivors had effective relief on discharge from hospital, the success rate falling to 73% at six months, and 55% at one year of follow-up. The operation was judged successful for patients with malignant disease because of short life expectancy.Thirteen patients had chronic pain from non-malignant conditions, and 85% obtained initial relief, the success rate falling to 35% at one year, and 20% at three years of follow-up.Two patients died from respiratory failure, giving an operative mortality of 3.5%. The results and complications of open cordotomy are compared with those of the percutaneous method, and the role of this procedure discussed in relation to alternative stimulatory analgesic procedures.