靶向椎间孔成形技术与常规穿刺置管技术治疗腰椎间盘突出症的对比研究

目的 比较经皮内镜靶向椎间孔成形技术与常规穿刺置管技术进行经皮椎间孔镜下椎间盘切除术（PTED）治疗腰椎间盘突出症（LDH）的临床疗效。方法 回顾性分析2017年9月至2018年12月行PTED治疗的91例单节段LDH的临床资料，其中43例采用靶向椎间孔成形技术穿刺置管（靶向成形组），48例采用常规穿刺置管（常规组）。术前、术后1 d、1个月、3个月、末次随访时，采用视觉模拟量表（VAS）评分及Oswestr功能障碍指数（ODI）评估腰腿痛改善情况及功能恢复情况。末次随访时，采用改良Macnab评分标准评定优良率。结果 与常规组相比，靶向成形组透视次数明显减少、通道建立时间和手术时间明显缩短（P<0.05）。两组术后VAS评分、ODI较术前均明显改善（P<0.05），但两组之间无统计学差异（P>0.05）。末次随访改良MacNab评分:靶向成形组优 28 例，良12例，可2例，差1例，优良率为93.02%；常规组优27例，良17例，可4例，优良率为 91.67%。两组优良率无统计学差异（P>0.05）。结论 靶向椎间孔成形技术可有效降低PTED的学习曲线，减少术中透视次数及手术时间     

双通道椎间孔镜技术治疗腰椎管狭窄症的初步临床研究

目的初步探讨采用双通道椎间孔镜技术治疗退变性腰椎管狭窄症的临床疗效。方法回顾性分析5例采用双通道椎间孔镜技术治疗退变性腰椎管狭窄症病人的临床资料,统计病人的手术时长、出血量、住院时间等临床资料,术后通过Oswestry功能障碍指数(ODI)、腰椎日本骨科协会(JOA)评分及视觉模拟评分法(VAS)对治疗效果进行评价。结果 5例病人均顺利完成手术,手术时长(110.6±18.9) min,术中出血量(15.2±9.7) ml,住院时间(4.5±1.2) d。病人术后间歇性跛行及神经根性症状均明显缓解;无术中及术后并发症。术后ODI、JOA、VAS评分改善率分别为48.7%、69.1%和62.0%。结论双通道椎间孔镜技术能安全、有效地治疗退变性腰椎管狭窄症,其手术创伤小,病人术后恢复快。该技术具有术野开阔、操作灵活的特点,是手术疗效、手术效率与微创的合理平衡。     

椎间孔镜偏心环锯技术治疗腋下型腰椎间盘突出症

目的观察经皮椎间孔镜偏心环锯技术治疗L5～S1腋下型腰椎间盘突出症(LDH)的临床疗效。方法回顾性分析40例L5～S1腋下型LDH,均行经皮椎间孔镜下偏心环锯技术治疗。采用Oswestry功能障碍指数(ODI)、视觉模拟评分(VAS)及改良MacNab标准评价临床疗效。结果病人均顺利完成手术,手术时间(72.36±15.79) min,透视次数(15.44±3.51)次,术后卧床时间(7.36±1.46) h。随访(14.68±3.89)个月,术后VAS、ODI评分均较术前明显降低(P 0.01),末次随访优良率为87.50%。结论经皮椎间孔镜偏心环锯技术能有效治疗L_5～S_1腋下型LDH,近期疗效确切,远期疗效有待进一步随访。     

不同治疗方案对胸腰椎体骨折疗效和神经损伤的影响

目的探讨不同治疗方案对胸腰椎体骨折疗效和神经损伤的影响。方法 50例胸腰椎体骨折根据治疗方式不同分为观察组和对照组。对照组接受传统的剥离伤椎椎旁肌肉治疗方式,观察组接受后路椎弓根Schanz螺钉内固定术部分剥离伤椎椎旁肌肉的治疗方式。对比2组手术时间、术中出血量、术后出血量、术前和术后1周疼痛视觉模拟量表评分(VAS)、椎体高度矫正率以及后凸Cobb角矫正率。结果观察组术中出血量和术后出血量明显低于对照组,手术时间明显短于对照组,差异均有统计学意义(P0.05);2组椎体高度矫正率及后凸Cobb角矫正率差异均无统计学意义(P0.05);观察组术后1周后VAS评分明显低于对照组,差异有统计学意义(P0.05)。结论与传统后路手术方法相比,后路椎弓根Schanz螺钉内固定术部分剥离伤椎椎旁肌肉治疗胸腰椎骨折出血量少,手术时间短,疼痛程度低,恢复快,对神经损伤修复好,值得临床推广。     

经皮椎间孔镜技术治疗腰椎间盘突出症和腰椎间孔狭窄的并发症原因分析与处理

目的分析经皮椎间孔镜技术治疗腰椎间盘突出症和腰椎间孔狭窄的并发症及其原因和相应处理措施。方法采用经皮椎间孔镜技术治疗286例经X线、CT或MRI证实的腰椎间盘突出症(201例)和腰椎间孔狭窄(85例)患者,视觉模拟评分(VAS)评价手术前后疼痛情况、Macnab标准评价手术疗效,记录手术相关并发症并分析原因及相应处理措施。结果与术前相比,术后3个月随访时VAS评分减少[1.00(0.00,1.50)分对8.50(7.75,9.25)分;Z=2.825,P=0.050];Macnab标准优良率达95.45%(273/286)。286患者中神经损伤8例(2.80%)、术区出血和神经根周围血肿形成6例(2.10%)、硬脊膜囊破裂1例(0.35%)、肌肉痉挛3例(1.05%)、感染1例(0.35%)、术后复发4例(1.40%),均予对症治疗后痊愈。结论经皮椎间孔镜技术治疗腰椎间盘突出症和腰椎间孔狭窄总体疗效满意,手术相关并发症发生率较低,通过术前评估,术中精细操作、仔细止血、缩短手术时间,以及术后对症处理,可以有效减少并发症的发生。     

微创经椎间孔腰椎间融合术联合经皮螺钉内固定融合术治疗退行性腰椎滑脱

目的探讨微创经椎间孔腰椎间融合术(MIS-TLIF)联合经皮螺钉内固定融合术治疗退行性腰椎滑脱的临床疗效。方法采用MIS-TLIF联合经皮螺钉内固定融合术共治疗32例退行性腰椎滑脱患者,比较术前和术后1周、3个月、末次随访时视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)和36条简明健康状况调查表(SF-36)评分,以及X线测量腰椎前凸角、冠状位Cobb角、冠状位和矢状位躯干偏移、腰椎滑脱程度(Meyerding分度)并计算滑脱率,X线或CT判断椎体融合率,MRI评价减压程度。结果 32例患者平均手术时间160 min,术中出血量120 ml,住院时间7.22 d,术后随访10.83个月。手术融合41个椎体节段,范围覆盖L2~S1节段。与术前相比,术后1周、3个月和末次随访时VAS(均P=0.000)和ODI(均P=0.000)评分增加,SF-36评分减少(P=0.002,0.000,0.000),腰椎前凸角(均P=0.000)、冠状位Cobb角(均P=0.000)和滑脱率(均P=0.000)均减小。至末次随访时,ODI改善率为(80.51±6.02)%,椎体融合率达92.22%且螺钉位置均良好。32例患者中1例术后感染、2例脑脊液漏,经对症治疗均痊愈;无一例发生神经功能缺损等严重并发症、内固定失败、椎弓根螺钉和钛棒断裂或Cage移位,无一例死亡。结论 MIS-TLIF联合经皮螺钉内固定融合术创伤小、术中出血量少、并发症轻微、复位效果好、疗效确切,尽管存在手术时间较长、学习曲线较长、术中X线照射量较大等缺点,但仍是治疗退行性腰椎滑脱的有效方法。     

微创经椎间孔腰椎间融合术联合经皮椎弓根螺钉内固定长节段融合术治疗退行性腰椎侧弯

目的探讨微创经椎间孔腰椎间融合术(MIS-TLIF)联合经皮椎弓根螺钉内固定长节段融合术治疗退行性腰椎侧弯的临床疗效。方法采用MIS-TLIF联合经皮椎弓根螺钉内固定长节段融合术治疗17例退行性腰椎侧弯患者,比较术前和术后1周、3个月、末次随访时视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)和36条简明健康状况调查表(SF-36)评分,以及X线测量冠状位Cobb角、矢状位前凸角、冠状位和矢状位躯干偏移,X线或CT判断椎体融合率,MRI评价减压程度。结果 17例患者手术融合56个椎体节段(T12~S1节段);平均手术时间200 min,术中出血量320 ml,住院时间8.21 d,术后随访12.13个月。与术前相比,术后1周、3个月和末次随访时VAS(均P=0.000)和ODI(均P=0.000)评分均减少,SF-36评分增加(均P=0.000),冠状位Cobb角(均P=0.000)、矢状位前凸角(均P=0.000)、冠状位和矢状位躯干偏移(均P=0.000)均减小。至末次随访时,ODI改善率(86.51±6.02)%,椎体融合率达89.21%,且螺钉位置良好。无一例出现术后神经功能缺损、感染、脑脊液漏等严重并发症,无一例内固定失败、椎弓根螺钉和钛棒断裂或Cage移位,无死亡病例。结论 MIS-TLIF联合经皮椎弓根螺钉内固定长节段融合术治疗退行性腰椎侧弯具有手术创伤小、术中出血量少、并发症发生率低、矫形效果好、疗效确切等优点,尽管存在手术时间和学习曲度较长等缺点,但仍是退行性腰椎侧弯微创治疗的有效方法。     

经椎板间入路椎间孔镜技术治疗腰椎间盘突出症疗效分析

目的探讨经椎板间入路椎间孔镜技术治疗腰椎间盘突出症的临床疗效。方法采用经椎板间入路椎间孔镜TESSYS技术治疗54例腰椎间盘突出症患者(L4-5椎间盘突出13例、L5-S1椎间盘突出41例),分别于术前和术后1 d、3个月、1年时采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价手术前后疼痛改善情况,复查腰椎MRI评价髓核摘除情况和有无复发。结果 54例患者手术成功率为96.30%(52/54),其中2例术中出现硬脊膜破裂,改为手术显微镜下椎板开窗、髓核摘除术。平均手术时间58.35 min,中位住院时间3 d。出院时52例疼痛消失、2例疼痛减轻,其中5例患侧小腿外侧麻木感加重。与术前相比,术后1 d、3个月和1年时VAS和ODI评分均减少(均P=0.000)。术后复查腰椎MRI显示髓核摘除满意,神经根压迫解除,亦未见复发。无一例发生感染等手术相关并发症,1例L5-S1椎间盘突出患者因髓核脱出椎管内游离较远,术中对神经根牵拉较重,术后出现S1神经根分布区麻木,术后1个月缓解。结论经椎板间入路椎间孔镜技术治疗腰椎间盘突出症临床疗效满意、安全性良好。     

经皮内镜椎间孔成形术治疗椎间孔狭窄性腰腿痛短期疗效观察

目的探讨侧后路经皮椎间孔镜下椎间孔成形术治疗椎间孔狭窄性腰腿痛的短期疗效。方法回顾性分析25例经MRI证实的椎间孔狭窄病例资料,采用侧后路经皮椎间孔镜下椎间孔成形术,其中腰L4～L5为9例,L5～S1 16例。分析治疗前及治疗后1周,术后1、3、6个月视觉模拟评分（visual analogue scale,vAs）变化及术后6个月MacNab评分。结果25例随访6。10个月,术后VAS较术前明显降低（P=0．000）。术后6个月MacNab评分：优11例,良12例,可2例,优良率92．0％。结论侧后路经皮椎间孔镜下椎间孔成形术治疗椎间孔狭窄性腰腿痛短期疗效满意。     

椎间孔镜下关节突可视化成型技术和显微镜微创通道技术治疗腰椎间盘突出症的临床疗效对比

目的 比较椎间孔镜下关节突可视化成型技术(VPTED)和显微镜微创通道技术(MITM)治疗单节段腰椎间盘突出症患者的临床疗效。方法 回顾性分析山西医科大学第一医院神经外科2019年10月1日—2021年10月31日期间收治的64例行手术治疗单节段腰椎间盘突出症患者的临床资料,其中采用VPTED治疗30例,采用MITM治疗34例。比较两组手术时间、术后住院时间、住院总费用及术后并发症、采用疼痛视觉模拟评分(VAS)和Oswestry残障指数(ODI)评价手术疗效并进行统计学分析。结果 VPTED组相比于MITM组,手术总时间及术后住院时间更短[(80.4±19.5)min/(111.5±25.2)min(P<0.05),(2.5±1.3)d/(4.2±2.3)d](P<0.05)。两组住院总费用相近,差异无统计学意义。两组术后各时间点VAS评分及ODI评分较术前均有下降(P<0.01);两组间术后各时间点VAS评分及ODI评分随访结果差异均无统计学意义(P>0.05)。MITM组患者术后复发1例,两组患者各有1例术后切口愈合不良。结论 椎间孔镜下关节突可视化成型技...     

Factors associated with satisfaction with care among patients with epilepsy

OBJECTIVE: The purpose of the work described here was to determine those variables associated with satisfaction with care among patients with epilepsy. METHODS: We interviewed patients followed at a tertiary epilepsy center. Predictor variables included age, gender, race, education, income, insurance, seizure frequency, and Quality of Life in Epilepsy-10 inventory (QOLIE-10) results. Target variables were the subscales of the Short Form Patient Satisfaction Questionnaire (PSQ-18). We used univariate analysis to identify those variables significantly associated with the subscales and multiple linear regression to determine those independently significant. RESULTS: The study population comprised 193 patients. Lower education and better QOLIE-10 scores were independently associated with general satisfaction with care. The mental health scale was associated with general satisfaction with care. Lower educational level was the only variable independently associated with patient satisfaction with communication, the financial aspect of care, and time spent with physician. CONCLUSION: Lower educational level and better quality of life are the main variables associated with higher general satisfaction with care among patients with epilepsy.     

Treatment with rituximab in patients with polyneuropathy with anti-MAG antibodies

Journal of Neurology -     

Surgical Outcome in Patients with Epilepsy with Occult Vascular Malformations Treated with Lesionectomy

Summary: Purpose: This retrospective study reports the long-term surgical outcome of patients with medically refractory epilepsy and vascular malformations who were treated with lesionectomy. A detailed analysis of surgical failures had been performed in an attempt to define predictors of surgical success and failure.
Methods: Fifteen patients with medically intractable epilepsy and angiographically occult vascular malformations (AOVMs) were treated surgically with lesionectomy at Duke University Medical Center. Lesionectomy consisted of removal of the AOVM and surrounding hemosiderin-stained brain only, without the use of electrocorticography (ECoG) to guide resection.
Results: Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant improvement, and one patient died, presumably after a seizure. Age of onset, duration of seizures, age at resection, and gender did not affect outcome. All patients with neocortical AOVMs in whom EEG findings correlated with the site of the lesion were seizure free after lesional resection. Treatment failures were associated with the presence of multiple intracranial lesions, poorly localized or diffuse EEG findings, discordant positron emission tomography (PET) imaging, or with a lesion in close proximity to the limbic system.
Conclusions: Lesionectomy, with removal of surrounding hemosiderin-stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy with occult vascular malformations.     

Children with ADHD and motor dysfunction compared with children with ADHD only

The purpose of this study was to identify group differences in children with attention-deficit-hyperactivity disorder and motor dysfunction (ADHD-MD) and ADHD only, and to evaluate the medication responsiveness of ADHD-MD. Sixty-three children (49 males and 14 females; mean age 9 years 10 months, SD 2 years 10 months) underwent a triple blind, placebo-controlled crossover study evaluating two dose levels of methylphenidate (0.3 mg/kg and 0.5 mg/kg [corrected], twice daily) and placebo. Forty-nine trials were completed. Nineteen were children with ADHD-MD, 44 had ADHD only. Behavior and functioning were assessed at home and at school. Treatment effects were assessed using the Abbreviated Symptom Questionnaire for Parents and Teachers. Children with ADHD-MD were more likely to have severe ADHD-combined type and other neurodevelopmental and behavioral problems. Both groups of children had a linear dose response to medication (placebo, low, high) and there was no evidence of a group by dose interaction or an overall group effect at home or school. The lack of group effect suggests that these children responded to medication like the other subgroups.     

Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism in women with bipolar disorder.

BACKGROUND: Preliminary evidence suggests that valproate is associated with isolated features of polycystic ovarian syndrome (PCOS), while contradictory data support an association between epilepsy and PCOS. The development of PCOS features after initiation of valproate was therefore examined in women with bipolar disorder using a standardized definition of PCOS. METHODS: Three hundred women 18 to 45 years old with bipolar disorder were evaluated for PCOS at 16 Systematic Treatment Enhancement for Bipolar Disorder sites. A comparison was made between the incidence of hyperandrogenism (hirsutism, acne, male-pattern alopecia, elevated androgens) with oligoamenorrhea that developed while taking valproate versus other anticonvulsants (lamotrigine, topiramate, gabapentin, carbamazepine, oxcarbazepine) and lithium. Medication and menstrual cycle histories were obtained, and hyperandrogenism was assessed. RESULTS: Among 230 women who could be evaluated, oligoamenorrhea with hyperandrogenism developed in 9 (10.5%) of 86 women on valproate and in 2 (1.4%) of 144 women on a nonvalproate anticonvulsant or lithium (relative risk 7.5, 95% confidence interval [CI] 1.7-34.1, p = .002). Oligoamenorrhea always began within 12 months of valproate use. CONCLUSIONS: Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism. Monitoring for reproductive-endocrine abnormalities is important when starting and using valproate in reproductive-aged women. Prospective studies are needed to elucidate risk factors for development of PCOS on valproate.     

血管内栓塞治疗未破裂脑动静脉畸形并发癫痫患者的预后分析

目的分析血管内栓塞治疗未破裂脑动静脉畸形(CAVM)并发癫痫患者的预后情况。方法选择2013年3月至2017年6月收治的符合诊断标准的CAVM并发癫痫发作患者49例为研究对象,分析血管内栓塞治疗后患者的临床症状、生活质量(QOLIE-31)改善情况。结果患者经血管内栓塞治疗后,QOLIE-31各项指标(除了药物影响)评分均明显提高,高于治疗前(P0.05);Spetzler-Martin分级与Engel分级的I~II级例数多于治疗前(P0.05),同时Spetzler-Martin分级I~II级生活质量评分(76.04±18.33)分明显高于III~V级的(65.65±16.76)分(P0.05);Engel分级I~II级的生活质量评分(75.25±17.78)分明显高于III~V级的(66.23±13.22)分(P0.05);血管内栓塞比例80%的生活质量总评分(78.37±18.87)分明显高于栓塞比例80%的(64.16±16.92)分(P0.05);术后患者的头疼症状中重度例数明显低于治疗前(P0.01);患者的NIHSS评分和MRS评分均明显低于治疗前,头疼症状的生活质量评分高于治疗前(均P0.05)。结论血管内栓塞能明显改善未破裂脑动静脉畸形并发癫痫患者的头疼症状、癫痫发作情况、神经功能缺损,提高血管内栓塞比例能够提高患者生活质量。