认识颈腰椎间盘病

目的 探讨颈腰椎间盘病的特点和诊断。方法 对近６年中的颈腰椎间盘突出症伴退变性椎管狭窄症和颈椎病并施行手术的５６例进行分析。结果 发现颈腰椎间盘突出症是本病的重要原因。结论 根据临床症状、体征和影像学检查,颈椎ＭＲＩ和腰椎ＣＴ检查,是防范混淆和误诊的必要条件。     

颈腰椎间盘病

目的： 探讨颈腰椎间盘病的特点和诊断。方法： 对近４ 年中的颈腰椎间盘突出症、退变性椎管狭窄和颈椎病并施行手术的１９ 例进行了分析。结果： 发现颈腰椎间盘突出症是本病的重要原因。结论： 根据临床症状、体征和影像学检查, 颈椎 Ｍ Ｒ Ｉ和腰椎 Ｃ Ｔ 检查, 是防范混淆和误诊的必要条件。     

认识颈腰椎间盘病

目的：探讨颈腰椎间盘病的特点和诊断。方法：对近6年中的颈腰椎间盘突出症、迟变性椎管狭窄症和颈椎病并施行手术的56例进行了分析。结果：发现颈腰椎间盘突出症是本病的重要原因。结论：根据临床症状、体征和影像学检查，颈椎MRI和腰椎CT检查，是防范混淆和误诊的必要条件。     

腰椎及椎管内肿瘤误诊腰椎间盘突出症5例报告

目的：分析腰椎及椎管内肿瘤误诊为腰椎间盘突出症的原因。方法：运用X线影像学诊断对腰椎及椎管内肿瘤与腰椎间盘突出症进行鉴别诊断。结果：4例行腰椎管造影,1例行腰椎正侧位X线片检查确诊。结论：在无MRI的医院,对腰椎间盘突出与腰椎及椎管内肿瘤的鉴别诊断,腰椎管造影的重要意义。     

胶原酶溶解术治疗椎间盘突出疗效及不良反应

目的 评价胶原酶治疗椎间盘突出症的疗效及不良反应。方法 采用颈椎硬膜外置管、腰椎间孔硬膜外、Ls-S1侧隐窝硬膜外前间隙胶原酶注射治疗颈、腰椎间盘突出症652例。结果 胶原酶溶解术治疗颈及腰椎间盘突出症有效率为92．3％、90．3％，主要不良反应为疼痛加剧、过敏反应、脊髓损伤、腰麻等。结论 胶原酶溶解术治疗腰及颈椎间盘突出症见效快、疗效较高、创伤小、操作简单。     

股骨头坏死误诊为腰椎间盘突出症原因分析

目的 分析股骨头坏死误诊为腰椎间盘突出症的原因。方法 收集和诊查有明确误诊为腰椎间盘突出症经历并有腰部CT或MRI检查的患者27例。结果 股骨头坏死误诊为腰椎间盘突出症24例，并发腰椎间盘突出症漏诊股骨头坏死3例，再次评价其腰部CT、MRI检测资料，存在腰是盘退变26例；腰椎间盘突出24例；腰椎体骨坏死2例。结论 临床病史资料了解不详，对类似症状未进行必要的鉴别，忽视临床查体，依赖CT、MRI检查结论，是误诊的关键因素；提出股骨头坏死与其并发的腰椎间盘退变和突出可能存在病理相关性，是误诊的内在因素。     

腰椎间盘突出症的生物力学研究

本文总结了对腰椎间盘突出症的有关生物力学研究。作者认为，腰椎间盘突出症系在椎间盘退变的基础上由于外力的急性或慢性作用使腰椎过载的结果，而椎间盘的退变、突出使腰椎的应力分布及载荷传递方式发生改变，从而可继发一系列病理变化。椎间盘切除和后部结构切除可对腰椎间生物力学功能产生重要影响，这可能是一部分腰椎间盘突出症手术疗效不佳的原因     

杠杆定位手法治疗腰椎间盘突出症

腰椎间盘突出症是骨伤科的常见病和多发病,治疗腰椎问盘突出症的手法较多,近年来,采用杠杆定位手法治疗腰椎间盘突出症93例,取得满意效果,现报告如下.     

腰骶部移行椎与腰椎间盘突出症的关系探讨

目的探讨腰骶部移行椎与腰椎间盘突出症的关系。方法将因非椎间盘突出症原因而行腰椎X线片检查的104例患者设为对照组;经手术证实腰椎间盘突出的91例患者设为腰椎间盘突出症组。比较两组患者的腰椎正位X线片,统计两组患者腰骶部移行椎发生率的差异及与移行椎与腰椎间盘突出部位的关系。结果对照组腰骶部移行椎发生率为18．3％,腰椎间盘突出症组为52．7％,两组间差异有统计学意义。腰椎间盘突出症组中合并移行椎者椎间盘突出发生于移行椎上一间隙者为58．3％;单侧移行椎椎间盘突出发生在移行椎畸形同侧者占75．9％,其中在移行椎上一间隙者占81．8％;发生在移行椎畸形对侧者占17．2％,其中在其下一间隙者占80．0％。结论腰骶部移行椎与腰椎间盘突出症有着密切关系,是诱发腰椎间盘突出症的重要危险因素之一。     

颈椎间盘突出症合并腰椎间盘突出症的非手术治疗

目的：研究非手术治疗颈椎间盘同症合江腰椎间盘同症的疗效。方法：核计从１９９０．２至１９９８．２,住院患者中颈椎间估出症合交腰椎间盘突出症５５例,同期颈椎间突出症３５７例,腰椎间盘突出症５８９例,分别占１５．４１％和９．３４％,优良率为８０％。而且作者描述了该疾病的症状、体征、非手术治疗的方法,同时介绍了牵引、推拿的注意事项。结论：非手术治疗（包括干扰素治疗）颈椎间盘突出症合并腰椎间盘突出症是有效的     

腰椎间盘手术失败原因分析和治疗

目的：对腰椎间盘手术失败的原因进行分析。方法：对129例腰椎间盘初次术后疗效不满意患者分析其原因，结果：在129列术后疗效不满意的患者中，需要再手术治疗的有98例（75．9％），初次手术失败的常见原因有椎间盘摘除不彻底或复发，保并有腰椎管狭窄（侧隐窝）狭窄的患者失能同时进行彻底地椎管减压、远期继发腰椎不稳以及选择了一些不恰当的手术病例等有关。结论：腰椎间盘术后症状复发原因较多，应充分结合患者的临床表现及影像学检查，严格掌握手术适应证。再手术目的的是解除疼痛，恢复功能，包括彻底减压和腰椎稳定性手术。     

Analysis of the clinical picture in patients with osteoarthritis of the spine depending on the type and severity of lesions on magnetic resonance imaging

Objectives

Spondyloarthritis is the most common pathological change in the spine. In a significant number of cases, it leads to compression of the nervous structures of the spinal canal, causing pain and neurological symptoms. Intervertebral disc pathology is a common cause of root deficits in neurological examination of all types of degenerative changes of the spine structures. Disc herniation is pathologically divided into 4 stages of herniated nucleus pulposus: 1) bulging, 2) protrusion, 3) extrusion, 4) sequestration. The aim of this study is to analyze the correlation between the type and severity of degenerative changes in the spine and the incidence of neurological deficits.

Material and methods

The study included 100 patients: 74 men and 26 women aged 50.2 ±10.43 years with pain of the spine in the cervical and/or lumbosacral segments and with degenerative changes in the plain radiographs. The mean value of body mass index (BMI) was 27.8 ±3.95 kg/m². Each patient underwent neurological examinations and 1.5 T magnetic resonance imaging MRI of the cervical and/or lumbar spine.

Results

Every patient was diagnosed with herniated nucleus pulposus affecting on average 4 ±2 segments of the spine. The most frequently observed degree of severity of disc herniation was the second (protrusion, 71.9% of all disc disease in 89 patients). Much less frequently found was the third degree (extrusion, 45 patients, 20.1% slipped disc), the first (bulging, 14 patients, 6.3% slipped disc), and least often only a small percentage of fourth degree (sequestration, 4 patients, 1.7% slipped disc). Neurological symptoms (deficits) were observed in 34 patients. They were accompanied by disc herniations in 23.7% of patients. In remaining patients with neurological deficits there was spinal stenosis. No correlation was observed between neurological deficits and stage 1 of disc herniation.

Conclusions

The incidence rate of neurological deficits is correlated with the degree of changes in the spine, as visualized by MRI.     

小切口加脊柱花刀治疗髓核骨化性腰椎间盘突出症

为保留腰椎后部结构的完整性，防止术后腰椎不稳，采用小切口单侧小开窗加脊柱花刀治疗旁侧型髓核骨化性腰椎间盘突出症22例，单侧扩大开窗加脊柱花刀治疗中央型髓核骨化性腰椎间盘突出症10例。手术尽可能地保留了腰椎全部结构的完整性，可防止术后腰椎不稳和减少对硬膜和神经根的疤痕粘连。并就32例髓核骨化性腰椎间盘突出症患者CT图像中髓核骨化的形式和形态进行了讨论。     

Pitfalls in computed tomography of the cervical and lumbar spine

In 10 patients, evaluated by computed tomography studies of the spine, radiological findings alone may have led to misinterpretation of the clinical condition. Five patients demonstrated CT findings of cervical disc herniation or protrusion, while clinical examination resulted in the diagnosis of neuralgic amyotrophy. In contrast, 3 patients with clinical signs of compression of lumbar nerve roots had negative findings in CT studies of the lumbar discs. Additional slices at the level of the vertebral body, however, demonstrated free sequestration of disc substance. Two patients with signs of compression of cervical roots had normal CT findings, but extensive disc herniation was present at surgery.     

Disc degeneration of cervical spine on MRI in patients with lumbar disc herniation: comparison study with asymptomatic volunteers

An association between progression of cervical disc degeneration and that of lumbar disc degeneration has been considered to exist. To date, however, this association has not yet been adequately studied. Age-related changes in the cervical intervertebral discs were evaluated by magnetic resonance imaging (MRI) in patients with lumbar disc herniation, and compared with the MRI findings of healthy volunteers without lower back pain. The purpose of this study was to clarify whether the prevalence of asymptomatic cervical disc degeneration is higher in patients with lumbar disc herniation than in healthy volunteers. The study was conducted on 51 patients who were diagnosed as having lumbar disc herniation and underwent cervical spine MRI. The patients consisted of 34 males and 17 females ranging in age from 21–83 years (mean 46.9 ± 14.5 years) at the time of the study. The control group was composed of 113 healthy volunteers (70 males and 43 females) aged 24–77 years (mean 48.9 ± 14.7 years), without neck pain or low back pain. The percentage of subjects with degenerative changes in the cervical discs was 98.0% in the lumbar disc herniation group and 88.5% in the control group (p = 0.034). The presence of lumbar disc herniation was associated significantly with decrease in signal intensity of intervertebral disc and posterior disc protrusion in the cervical spine. None of the MRI findings was significantly associated with the gender, smoking, sports activities, or BMI. As compared to healthy volunteers, patients with lumbar disc herniation showed a higher prevalence of decrease in signal intensity of intervertebral disc and posterior disc protrusion on MRI of the cervical spine. The result of this study suggests that disc degeneration appears to be a systemic phenomenon.     

腰椎间盘突出症的临床解剖学分型及其意义(1106例回顾性研究)

目的：对不同方向突出的椎间盘从解剖学角度给予区域界定,以便明确分型,利于术式选择。方法：通过对离体干化腰椎的解剖研究,结合临床术中测量及１１０６例回顾研究,将突出椎间盘进行明确解剖界定之分型。结果：同区域的突出椎间盘产生一组相似的临床表现,基于此,将椎间盘突出症分为５型,即：中央型、偏侧型、椎间管型、椎间管外型及侧方型。分别占发病间盘的３３４％、５１％、８５％、４５％、２４％。结论：解剖界定明确的分型,对腰椎间盘突出症临床诊断和术式选择有重要意义     

Coexistence of cervical and lumbar disc disease

A retrospective analysis of 200 patients requiring cervical disc surgery was performed to determine the frequency of coexistent lumbar disc or spine abnormalities. The duration of follow-up ranged from 5 to 25 years, averaging 14 years. Sixty percent were women and 40% were men, their ages ranging from 25-73 years. Antecedent motor vehicle injury had occurred in 49 cases and work injury to the spine in 23. Sixty-four percent had no history of prior back injury. It was found that over 31% had undergone lumbar disc surgery, and a high number of patients demonstrated abnormal lumbar radiographs or myelograms, including 78 with bulging discs, 100 with major root defects, 78 with minor root defects, 8 with spinal stenosis, and 7 with spondylolisthesis. Myelograms were normal in 22 cases. The sites of lumbar abnormalities included L4-5 (110), L5-S1 (90), and multilevel (8). There was a higher incidence of lumbar disc abnormalities associated with multilevel cervical spondylosis. There also was a relationship between residual symptoms and myelographic abnormalities. Two studies in the authors' institution suggest an autoimmune basis for the frequent coexistence of cervical and lumbar disc disease, namely the demonstration of antigenic properties in the nucleus pulposus and high serum immunoglobulins.     

腰椎间盘突出症有限化再手术的治疗

探讨腰椎间盘突出症再手术的有限化方法对疗效的影响。方法１９７５年以来收治４５例,采用有限的椎板及关节突切除,潜行扩大椎管。其中原切口切除留椎板显露２２例,扩大开窗或半椎板切除２３例。术中切除是盘３６例,侧隐窝狭窄减压１７处。结果经３年至１８年,平均５．１年随访。优良４０例,可２例,差３例。优良率８８．８％。结论有限化操作既能除髓核,也能行根管减压,脊柱损伤小,远期疗效好。