经皮激光颈椎间盘减压术对颈椎稳定性的影响

背景：经皮激光椎间盘减压术是一项脊柱微创手术新技术，逐步在临床广泛应用。目的：评价经皮激光椎间盘减压术对颈椎稳定性的影响。设计：以患者为研究对象，前后对照观察研究。单位：暨南大学附属第二医院深圳市人民医院脊柱外科。对象：2001-10／2003-04暨南大学附属第二医院深圳市人民医院脊柱外科收治侧旁型颈椎间盘突出症患者28例，29个椎间盘，男17例，女11例。干预：在X射线监视下，9号穿刺导针颈前穿刺，将4001μm光导纤维导入病损椎间盘内，使用波长1060nm的ND：YAG激光，输出功率15W，对髓核进行汽化、减压，接受激光剂量为500～950J。主要观察指标：观察治疗前及术后6个月手术椎间盘相邻椎体前后横向位移及成角情况。结果：过屈位、过伸位手术前后手术椎间盘相邻椎体的位移差异无显著性意义(t=0．8117～0．8272，P&;gt;0．05)；其相邻椎体角度大小差异无显著性意义(t=0．7687～0．8271，P&;gt;0．05)。结论：经皮激光椎间盘减压术治疗侧旁型颈椎间盘突出症，操作简易，损伤小，影响颈椎稳定性。     

经皮激光汽化减压术治疗单纯颈椎间盘突出症的临床应用

介绍经皮激光汽化减压术(PLDD)治疗单纯颈椎间盘突症，探讨其临床可行性。治疗单纯颈椎间盘突出症12例，平均住院1．7d，随访1～13个月，疗效可靠。     

经皮激光颈椎间盘减压术对颈椎稳定性的影响

背景经皮激光椎间盘减压术是一项脊柱微创手术新技术,逐步在临床广泛应用.目的评价经皮激光椎间盘减压术对颈椎稳定性的影响.设计以患者为研究对象,前后对照观察研究.单位暨南大学附属第二医院深圳市人民医院脊柱外科.对象2001-10/2003-04暨南大学附属第二医院深圳市人民医院脊柱外科收治侧旁型颈椎间盘突出症患者28例,29个椎间盘,男17例,女11例.干预在X射线监视下,9号穿刺导针颈前穿刺,将400μm光导纤维导入病损椎间盘内,使用波长1060nm的NDYAG激光,输出功率15 W,对髓核进行汽化、减压,接受激光剂量为500～950 J.主要观察指标观察治疗前及术后6个月手术椎间盘相邻椎体前后横向位移及成角情况.结果过屈位、过伸位手术前后手术椎间盘相邻椎体的位移差异无显著性意义(t=0.8117～0.827 2,P＞0.05);其相邻椎体角度大小差异无显著性意义(t=0.768 7～0.827 1,P＞0.05).结论经皮激光椎间盘减压术治疗侧旁型颈椎间盘突出症,操作简易,损伤小,影响颈椎稳定性.     

经皮激光椎间盘减压术治疗颈、腰椎间盘突出症疗效观察

目的探讨经皮激光椎间盘减压术（PLDD）对颈、腰椎间盘突出症的疗效。方法对81例椎间盘突出症患者采用PLDD治疗，观察其治疗效果。结果81例中优58例，良16例，可6例，差1例；优良率达91％。结论PLDD治疗颈、腰椎间盘突出症疗效确切，值得推广应用。     

102例颈椎间盘突出症病人行PLDD联合臭氧消融交替治疗的护理

总结102例颈椎间盘突出症病人行经皮穿刺激光椎间盘汽化减压术(PLDD)联合臭氧消融交替治疗的护理,强调做好术前准备、加强术后观察及并发症的护理,是手术成功的保证。     

经皮激光汽化减压术治疗单纯颈椎间盘突出症的临床应用

介绍经皮激光汽化减压术(PLDD)治疗单纯颈椎间盘突症,探讨其临床可行性。治疗单纯颈椎间盘突出症12例,平均住院1.7d,随访1～13个月,疗效可靠。     

应用体感诱发电位定量比较激光椎间盘减压术与胶原酶溶核术的疗效

观察比较经皮激光椎间盘减压术(percutaneous laser dise decompression，PLDD)与胶原酶溶核术(chemonucleolysis,CNL)治疗腰椎间盘突出症的疗效及特点。方法：将86例腰椎间盘突出症患，随机分为两组，分别采用非血管性介入技术，经皮穿刺激光汽化椎间盘和胶原酶溶核术治疗方法。所有病例于治疗前，治疗后1周，1，6个月，1年通过观察、随访，进行皮节体感诱发电位(dematomal somatosensory evoked potential，DSEP)测量和疗效评定。通过统计学分析比较两种治疗方法的疗效及特点。结果：PLDD治疗方法对解除神经受压、恢复神经功能的作用明显早于CNL治疗方法；术后1个月两的优良率分别为69％和65％，差异无显性意义；术后1年PLDD方法的优良率为86％显高于CNL方法(67％)，差异有显性意义。     

980 nm半导体激光减压术治疗椎间盘突出症286例

目的探讨980nm半导体激光经皮椎间盘减压术（PLDD）治疗腰椎间盘突出症的疗效。方法286例患者局麻后在C型臂X射线机透视下确定病变椎间盘平面，以每个椎间盘600～800J激光能量行PLDD。参照Choy评分法评价疗效。结果经1年以上随访，0～2分者（优）188例（65．8％），3～5分者（良）41例（4．1％），6～10分者57例（20％）；无椎间盘炎及其他并发症发生。结论PLDD能有效缓解椎间盘源性疼痛。     

经皮激光椎间盘减压术对颈椎间盘突出症的治疗

经皮激光椎间盘减压术（PLDD）是继化学溶核术（Chmon—nucleolysis）、经皮椎间盘髓核摘除术（APLD）等之后出现的又一种椎间盘微创治疗技术，其特点具有创伤小，安全性高，疗效确切，操作简便等，并且可在门诊进行，其应用方面已有一定的报道。近年来其在颈椎间盘突出症的治疗上也日益增多，本文就当前经皮激光椎间盘减压术对颈椎间盘突出症的治疗情况总结如下。     

经皮激光椎间盘汽化减压术治疗椎间盘突出症的护理

总结了对48例椎间盘突出症患者实施经皮激光椎间盘汽化减压术(PLDD)治疗的护理要点,包括术前的健康教育、心理护理、术前准备;术中的护患交流;术后并发症的防治、康复锻炼以及出院后延续1～6个月的跟踪随访.认为护士在熟悉PLDD的治疗原理及方法的基础上,根据患者的病情采取有效的护理措施,可以为患者的治疗创造良好的条件,有效地防止并发症的发生,确保PLDD治疗的成功.     

MRI of the intervertebral disc in lumbar disc disease

Background. MRI of the intervertebral disc in discopathy of the lumbar spine have been presented.
Material and methods. a group of 51 patients clinically diagnosed as discopathy of the lumbar spine were subjected to three MR imaging procedures. Imaging was performed before surgery, 6 weeks after surgery, and 12 weeks after surgery.
Results. The MRI was consistent with the surgery findings in 88.2% of cases. Instead, images taken 6 weeks after surgery were non-characteristic and difficult to differentiate. In the spinal canal tissue was visible with the image similar to nucleus pulposus herniation, granulation from a growing haematoma, or after surgery scar. Twelve weeks after surgery, the MR image is characteristic and correlated with the patient's clinical state.
Conclusions.
1. MRI image allows an evaluation of intervertebral disc healing after discectomy.
2.MRI 12 weeks post-surgery correlates with patient's clinical symptoms.
3.MRI with Gd-DTPA contrast enhanced allows a precise analysis of the causes of unsatisfactory results of operative treatment.
     

Anatomy of intervertebral disc and pathophysiology of herniated disc disease

This discussion reviews developments in normal and abnormal disc biology over the past decade. The anatomic and biochemical structure of the disc is reviewed. Emphasis is placed on recent neurochemical changes identified in disc degeneration and disc herniation. Biomechanical considerations for the normal disc are presented. Influence of mechanical factors on disc nutrition, disc degeneration and disc herniation is reviewed. Biologic events underlying the diagnostic methods used in evaluating disorders of the intervertebral disc are presented. The biologic consequences of iatrogenic disc injury in discectomy are also discussed.     

椎间盘和椎间隙的影像学对比观察

目的 对椎体病变中椎体形态改变后MRI上相邻的椎间盘和X线平片上相应的椎间隙进行对照研究,分析二者变化之间的相关性,提高对X线平片的认识.方法 回顾性搜集41例同时行X线平片和MKI平扫检查的椎体病变资料,男25例,女16例,年龄5～82岁,平均49.3岁.对比观察X线上椎间隙和MRI上椎间盘的变化.结果 椎体病变中MRI上Ⅰ型、Ⅱ型和Ⅳ型椎间盘在X线平片上多表现为椎间隙正常,少数表现为椎间隙变窄;Ⅲ型和V型椎间盘在X线平片上多表现为椎间隙变窄.结论 X线平片上椎间隙改变在一定程度上可以反映椎间盘的改变,但不能完全真实地反映椎间盘的改变.     

Artificial disc replacement--evolutionary treatment for degenerative disc disease

Back pain is a common problem that affects the majority of people at some point in their lives. Most back pain is not serious, but back pain caused by injury and aging can result in chronic pain that can last months, years, or indefinitely. Arthrodesis (ie, spinal, fusion) has been the treatment of choice for symptomatic degenerative disc disease that has not responded to conservative treatment modalities. Artificial disc replacement is a more recent option that preserves spinal motion but also recreates the natural function of the disc. The history of artificial disc replacement surgery, preoperative preparation, the surgical procedure, and postoperative recovery are discussed.     

Result of laser-assisted disc ablation after unsuccessful percutaneous disc decompression

OBJECTIVE: The author assessed results of laser-assisted disc decompression (LADA) in patients who already had earlier unsuccessful percutaneous discectomy (PD) at the same level. SUMMARY BACKGROUND DATA: The efficacy of LADA after failed PD for the same disc level is not well established. However the literature does not suggest any contraindication to performing LADA in previously failed PD. METHODS: Prospective study of LADA after failed PD at the same disc level in 15 patients was done. Results were assessed clinically using the Japanese Orthopaedic Association (JOA) scale for an average follow up of 13 months. RESULTS: No patient had excellent recovery, 7 patients had poor recovery, 5 patients had fair recovery, and only 3 patients had good recovery. None of the patients had worsening of symptoms after the LADA. CONCLUSIONS: Repetition of another form of minimally invasive surgery by laser (Neo:Yag) for the same level of disc herniation after unsuccessful PD has low rate of success.     

腰腿痛患者关节突关节不对称与椎间盘退变和突出的关系

目的：研究腰腿痛患者关节突关节不对称与椎间盘退变和突出的关系。方法：通过151例腰腿痛患者CT片观察椎间盘突出状况和测定关节突关节角度,其中73例患者还做了MRI检查,了解关节突关节不对称与椎间盘退变的关系。结果：关节突关节不对称与椎间盘退变和突出有关,而椎间盘突出方向与关节面的偏向无关。结论：关节突关节不对称增加了椎间盘退变和突出的危险性。     

Medium-term outcomes of artificial disc replacement for severe cervical disc narrowing

ObjectiveTo determine if the Bryan cervical disc prosthesis could relieve objective neurological symptoms, signs, and restore mobility in patients with severe cervical disc narrowing.MethodsClinical data of thirty-two patients underwent Bryan cervical disc replacement has been collected from April 2006 to February 2010. Severe cervical disc narrowing with grade V disc degeneration were included in this study. Bryan cervical disc prostheses have been implanted through anterior approach. Japanese Orthopedics Association (JOA) score, visual analog scale, Odom's scale, and flexion-extension radiological follow-ups were applied for evaluations.ResultsA total of 41 Bryan disc prostheses from 32 patients with an average follow-up duration of 33.5 months (range 23 to 44 months) were evaluated. Clinical functions of patients were significantly improved. Preoperative averaged visual analog scale score of 6.3±2.2 was decreased to 1.3±1.2 (at 36 months, P<0.001), while preoperative averaged JOA score of 14.4±1.2 was increased to 16.3±0.9 (at 36 months, P<0.001). Thirty of 32 patients received excellent to good outcomes in Odom's scale. Averaged mobility was restored to (9.9±3.2)° at the last follow-up evaluation of 36 months. No subsidence or migration of implant was identified.ConclusionsAcceptable clinical outcome for treatment of severe cervical disc narrowing with cervical disc replacement technique has been performed in current study. Most patients maintained good postoperative mobility and no significant adjacent level degeneration were found. Cervical disc replacement may be applicable in treatment of severe cervical disc narrowing; however, longer follow-ups are required for ensuring the long-term efficacy of cervical disc replacement.     

人工髓核假体置入治疗腰椎间盘突出症的疗效分析

目的：观察已在临床初步开展起来的人工髓核置换术治疗腰椎间盘突出症的中、远期临床疗效及并发症,分析其对策。 方法：纳入2002-02/2004-08南方医科大学附属南方医院脊柱骨病外科采用单枚人工髓核假体置换术治疗单节段腰椎间盘突出症患者98例,获得24～48个月随访患者75例,按平均随访时间达24,36,48个月,分为24个月组（n=30）,36个月组（n=23）,48个月组（n=22）。选同期采用单纯椎间盘髓核摘除术患者30例作为对照组,评估各组术后临床疗效,主观症状采用Oswestry功能障碍指数问卷表（0%表示正常,越接近100%则功能障碍越严重）和Prolo功能评分表（小于或等于5分为差,6～7分为中等,8～10为优）评价,分析术后影像学检查并测量手术节段活动度和椎间隙高度变化情况,同时观察假体位置情况,腰椎MRI观察假体位置和软骨终板的信号变化情况。腰椎活动度=（腰椎中立角度-前屈角度）＋（后伸角度-腰椎中立角度）=后伸角度-前屈角度;为消除X射线放大率的影响,椎间隙高度变化情况采用病变椎间隙后缘高度与上位椎体中部矢状径的比值表示。 结果：75例获得24～48个月随访者,全部进入结果分析。①48个月组2例、36个月组1例发生假体脱出,二次手术取出。其余患者术后临床症状均明显缓解,疼痛消失。②24,36,48个月组及对照组术后末次Oswestry功能障碍指数均较术前降低,差异有显著性意义（14.2%,52.1%;15.5%,55.2%;15.1%,53.6%;15.5%,51.5%;P〈0.05）。③24,36,48个月组及对照组术后末次Prolo能评分均较术前升高,差异有显著性意义（8.5,4.6分;8.6,4.5分;8.7,4.3分;8.4,4.2分;P〈0.05）。④24,36,48个月组同期手术节段腰椎活动度均高于对照组,差异有显著意义（P〈0.05）。⑤24个月组手术节段椎间高度较术前降低约4%、36个月组降低约12%、48个月组降低约18%、对照组较术前降低约25%,各组术前和术后椎间隙高度比值比较,差异具有显著性意义（P〈0.05）。⑥主要并发症：早期出现术后一过性腰痛24例,假体脱出3例。中、远期发现假体下沉32例,软骨终板损伤39例。 结论：单枚人工髓核假体置换治疗腰椎间盘突出症中、远期随访临床疗效肯定,但存在较严重并发症,应慎重开展此项手术。