复合疗法治疗腰椎间盘突出症36例

本组通过对３６例腰椎间盘突出症病人行硬膜外腔注射药物加牵引治疗，取得满意效果，现报告如下。１资料与方法 ３６例病人均经腰椎ＣＴ扫描或Ｘ线摄片诊为腰椎间盘突出症，排除其他原因所致腰腿痛，其中男 ２５例，女 １１例；年龄１９—６５岁；病程１个月～４年；病变部位Ｌ３－４为５例，Ｌ４－５为１２例，Ｌ６～Ｓ１为１９例；均有不同程度的腰腿痛，活动受限，２例生活不能自理，椎间隙变窄者２８例，合并骨质增生１７例。治疗方法采用硬膜外腔注射药物，穿刺部位一般为病变上一个间隙。药物为 ２％利多卡因 ５ ｍｌ、地塞米松 １０ …     

腰椎硬膜外腔胶原酶注射髓核溶解法治疗腰椎间盘突出症45例疗效分析

目的 探讨腰椎硬膜外腔胶原酶注射治疗腰椎间盘突出症的疗效。方法 采用患侧卧位，相应部位行硬膜外穿刺，将硬膜外导管置入病变椎间盘对应的硬膜外腔后，在此腔内注射胶原酶1200^U（上海乔源生物制药有限公司生产的注射用胶原酶（Collagenase）1200^U／支），术后腹卧位休息3d，同时给予脱水、抗炎等治疗，减轻药物刺激引发的神经根水肿。3d后开始下床活动。结果 本组45例腰椎间盘突出症患者经腰椎硬膜外腔胶原酶注射髓核溶解治疗后36例症状缓解或明显减轻，6例于术后症状体征有所减轻，3例无效。讨论 腰椎硬膜外腔胶原酶注射治疗腰椎间盘突出症为一非手术方法治疗椎间盘突出症的方法，创伤小，恢复快，并发症少。只要适应证选择恰当常能获得较满意的疗效。     

硬膜外注射配合手法复位治疗急性腰椎间盘突出症的临床及电生理研究

目的：探讨硬膜外注射配合手术复位对急性腰椎间盘突出症的疗效并观察体感诱发电位在病情评估中的作用。方法：将46例急性腰椎间盘突出患者随机分为硬膜外注射组23例和常规治疗组23例，疗程3-4周，治疗前及治疗后1d、1周及疗程结束 后应用目测类比评分法（VAS）对疼痛进行评估，对症状、体征进行临床评定，治疗后进行疗效评定并复查双下肢体感诱发电位。结果：硬膜外注射即对止痛效果明显，可缩短疗程，配合手法复位治疗，疗效显著，优良率占82.6％。两组患者患侧下肢体感诱发电位潜伏期延长，神经传导速度减慢，治疗后均有改善。结论：硬膜外注射配合手法复位对急性腰椎间盘突出症有较好的临床疗效，体感诱发电位可作为腰椎间盘突出症病情及疗效评定的指标。     

硬膜外腔注药治疗腰椎间盘突出症36例

经对腰椎间盘突出症急性期患者行突出部位硬膜外腔注射疗法，并结合牵引及物理因子综合治疗，取得了良好疗效，现报道如下，１对象与方法１．１对象治疗组为伊犁哈萨克自治州友谊医院住院患者３６例。男１９例，女１７例，年龄２３～７５（４０±１７）岁；病程１d～半年。所有患者均经CT或MRI确诊，临床检查均表现为腰、腿痛，直腿抬高、屈颈试验阳性。３６例患者中维族１３例，汉族１３例，哈族９例，锡族１例。影像结果显示，L４～５突出２２例，L４～５～S１突出６例，L５～S１突出８例。患者临床症状及体征均表现为典型的坐骨神经…     

综合治疗腰椎间盘突出症的疗效观察

腰部牵引疗法配合高频或中频电疗治疗腰椎间盘突出症，均取得较好疗效，尤其是后者，有效率达９６２％、报告如下。１资料和方法１．１临床资料腰椎间盘突出症患者２０１例，男８８例．女ｕ３例，年龄１９～６８岁，平均年龄４０岁．病程最短的１周，最长２０ａ，随机分为两组，Ａ组（７０例）和Ｂ组（１３例）；都经ＣＴ或核磁共振检查，其中Ｌ４－５椎间盘突出者１３８例，Ｌ４－Ｓ１椎间盘突出者４１例．多发性腰椎间盘突出者１２例，其他部位１０例。１．２治疗方法我们采用江苏常熟保健器材厂制造的ＬＤ－２型全身理疗按摩床，牵引后加…     

硬膜外腔药物注射治疗腰椎间盘突出症临床分析

目的分析硬膜外腔药物注射治疗腰椎间盘突出症的临床效果。方法取硬膜外腔后间隙穿刺置管2cm，摆好体位后，经导管注入溶有生理盐水5ml、2％利多卡因5ml、曲安奈德20mg、维生素B12：2mg、东莨菪碱10mg、维生素B6100mg的混合液。结果治疗126例，经3个月以上随访，优良113例（89．7％），尚可11例（8．7％），差2例（1．6％）。结论 硬膜外腔药物注射治疗腰椎间盘突出症，操作简便，安全性高，疗效显著。     

综合治疗腰椎间盘突出症108例体会

１资料与方法腰椎间盘突出症１０８例,男６８例,女４０例,年龄１７～６５岁,发病时间３ｄ～１４年,６７例以腰痛、局部压痛、患肢放射痛为主症;３４例表现为髋及下肢麻木并放射痛,无腰痛;７例表现为一侧膝以下疼痛,全部病例均根据临床症状、体征、并行ＣＴ扫描后确诊。Ｌ４、５突出５２例,Ｌ５Ｓ１,突出４０例,Ｌ３,４突出３例,Ｌ４,５合并Ｌ５Ｓ１突出１０例,Ｌ３、４合并Ｌ４、５、Ｌ５Ｓ１突出３例;其中合并椎管狭窄２６例,侧隐窝狭窄１２例,黄韧带肥厚１０例,椎间盘部分钙化８例。治疗方法（１）成角旋转快速牵引:患者俯卧,胸背部及腰臀…     

腰椎间盘突出症的临床检查

腰椎间盘突出症的临床检查岳寿伟腰椎间盘突出症（Ｌｕｍｂａｒｄｉｓｃｈｅｒｎｉａｔｉｏｎ，ＬＤＨ）主要指下腰椎，尤其是Ｌ４～５、Ｌ５～Ｓ１、Ｌ３～４的纤维环破裂和髓核组织突出压迫和刺激相应水平的一侧或双侧坐骨神经根所引起的一系列症状和体征。腰椎间盘突...     

双向牵引加硬膜外封闭治疗腰椎间盘突出症96例报告

自１９９３～１９９８年，我院采用双向牵引加硬膜外封闭治疗腰椎间盘突出症９６例，效果理想，现报告如下。１　临床资料本组９６例患者，男５９例，女３７例；年龄最小１７岁，最大６７岁，平均４６－５岁；病程为５ｄ～７ａ；本组病例均根据临床症状体征、ＣＴ及ＭＲＩ检查确诊。疼痛类型：腰痛伴单侧下肢疼痛、间歇性跛行等不适者４１例，腰痛伴双下肢痛者１７例，单纯单侧下肢放射痛者２２例，双侧下肢放射痛者１１例，劳动后出现症状者单侧４例，双侧１例。左侧３８例，右侧３０例，中央型２８例。Ｌ３～４者５例，Ｌ４～５者３５例。…     

一松、二扳、三运动推拿治疗腰椎间盘突出症350例

１资料与方法 资料：选择１９９６年８月～１９９９年８月腰椎间盘突出症３５０例,依据临床表现体征结合Ｘ线拍片、ＣＴ和ＭＲＩ等辅助检查确诊。男２３４例,女１１６例,年龄１８—６５岁,病程３ｄ～３年。其中腰痛伴一侧下肢痛２４０例,占６８％;腰痛伴双下肢痛３０例,占８％;单纯一侧下肢痛９０例,占２６％;脊柱侧弯１８０例,占５１％。Ｌ３－４突出者４０例;Ｌ４－５突出者１３０例;Ｌ５～Ｓ１突出者１１０例;Ｌ３～４、Ｌ４－５突出者３０例;Ｌ４－５、Ｌ５～ Ｓ１突出者 ４０例． ＣＴ检查阳性率 ３ １４例,占９０％。…     

山羊腰椎间盘退变模型硬膜外胶原酶的注射

背景:采用椎间盘外、硬膜外腔注射胶原酶治疗椎间盘突出症的机制,目前尚不完全清楚。目的:观察硬膜外注射胶原酶对椎间盘退变动物模型的作用。方法:成年山羊6只,麻醉后作侧外方切口至腰椎体腹侧,椎板加压并用钢板螺钉固定,L1/L2,L3/L4椎间盘分别注射0.5无水乙醇建立椎间盘退变模型。硬膜外注射实验用胶原酶1mL,2周后处死动物,取出椎间盘,作电镜切片观察。结果与结论:电镜下显示:退变的椎间盘纤维环上有裂隙,退变的椎间盘的胶原纤维明显溶解,未退变的椎间盘未有溶解。提示硬膜外注射胶原酶通过纤维环上的裂隙渗透到盘内,发生化学溶解作用,从而达到治疗作用。     

Re-operation after lumbar disc surgery: results in 85 cases

In this retrospective study, 85 patients previously operated on for lumbar disc herniation who had undergone re-operation due to persistent pain or recurrence of the symptoms were investigated. The surgical findings were: recurrent herniation (20%), epidural fibrosis alone (36.4%), small recurrent herniation with epidural fibrosis (28.2%), herniation at another level (10.6%), spinal stenosis (2.4%), lumbar pseudomeningocele (1.2%) and adhesive arachnoiditis (1.2%). The overall success rate of re-operation was 60%. The best results were obtained in recurrent disc herniation (47.1%) excellent and 35.3% good results) and in herniation at another level (77.8% excellent and 22.2% good). Re-operation in epidural fibrosis had less-satisfactory results (29.1% excellent and 12.9% good).     

山羊腰椎间盘退变模型硬膜外胶原酶的注射

背景：采用椎间盘外、硬膜外腔注射胶原酶治疗椎间盘突出症的机制,目前尚不完全清楚。目的：观察硬膜外注射胶原酶对椎间盘退变动物模型的作用。方法：成年山羊6只,麻醉后作侧外方切口至腰椎体腹侧,椎板加压并用钢板螺钉固定,L1/L2,L3/L4椎间盘分别注射0.5无水乙醇建立椎间盘退变模型。硬膜外注射实验用胶原酶1mL,2周后处死动物,取出椎间盘,作电镜切片观察。结果与结论：电镜下显示：退变的椎间盘纤维环上有裂隙,退变的椎间盘的胶原纤维明显溶解,未退变的椎间盘未有溶解。提示硬膜外注射胶原酶通过纤维环上的裂隙渗透到盘内,发生化学溶解作用,从而达到治疗作用。     

Epidural gas-containing pseudocyst leading to lumbar radiculopathy: A case report

BACKGROUNDLumbar radiculopathy is a common symptom in the clinic and is often caused by lumbar disc herniation or osteophytes compressing the nerve root; however, it is rare for nerve roots to be compressed by epidural gas. Few symptomatic epidural gas-containing pseudocyst cases have been reported. Furthermore, the reported cases were due to a mix of gas and obvious osteophytes; therefore, it was hard to rigorously conclude that gas was the factor responsible for radiculopathy. We provide evidence that because no epidural gas accumulated before radiculopathy occurred and the symptoms were relieved after removal of the gas, the epidural gas-containing pseudocyst was the root cause of radiculopathy in this case.CASE SUMMARYAn 87-year-old man with a 3-wk history of right radiating pain was admitted to our hospital. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations showed a vacuum phenomenon and huge lesions with low signal intensity located in the same area where the pain occurred. After carefully checking the images acquired in the last 3 mo, we found an abdominal CT examination performed 40 d prior because of abdominal pain. The CT images showed no gas-containing pseudocyst in the epidural space and notably, he had no leg pain at the time. To ensure a low-intensity intervention and complete decompression of the nerve, percutaneous endoscopic lumbar nerve decompression surgery was advised. A gas-containing pseudocyst was identified under endoscopy. The symptoms were relieved after surgery, and the postoperative images showed total disappearance of the vacuum phenomenon and lesions with low signal intensity on CT and MRI. Histological examination showed that the sampled gas-containing pseudocyst tissue was fibrous connective tissue.CONCLUSIONThis case thoroughly illustrates that an epidural gas-containing pseudocyst can result in radiculopathic pain through a comprehensive evidence chain. Percutaneous endoscopic decompression is a minimally invasive and effective treatment method.     

CT导引下硬膜外穿刺置管注射胶原酶治疗颈椎间盘突出症的临床探讨

目的 探讨CT导引下硬膜外穿刺置管注射胶原酶治疗颈椎间盘突出症的临床疗效。方法 CT导引下硬膜外穿刺置管治疗颈椎间盘突出症37例，根据疗效评定标准：优：症状及体征完全消失，半个月后恢复原工作。良：主要症状及体征消失，可维持原工作。可：症状及体征有好转，能做轻工作。差：症状与体征均无明显好转。术后随访3—9个月。结果37例优18例、良16例、可2例、差1例，优良率91.89％。术后3个月复查CT20例，15例突出颈椎间盘影像消失或明显缩小、5例突出椎间盘有不同程度缩小。无1例并发症发生。结论 CT导引硬膜外穿刺置管治疗颈椎间盘突出症具有影像直观，定位准确、优良率高等优点，是治疗颈椎间盘突出症的一种有效方法。     

透明质酸钠预防术后硬功夫膜外瘢痕粘连性疼痛的研究

Laminectomyandremovalofnucleuspulposusisthemostlyusedsurgeryforlumbarintervetebraldischerniation．Incidenceoffailedbacksurgerysyndromeaftersurgeryisabout６％～１５％．Thecausemaybeduetoepiduralscarandadhesionorfixationofnerverootwhichwillcompressnerverootandresultinreoccurredischialgianeuralgiaandlowbackpain．Inordertopreventepiduraladhesionandscarformationandimprovetherapeuticeffectoflumbarsurgery，wepreventadhesionandscarformationusingsodiumhyaluronateproduct（SHP）asadhesioninhbitor．Ther…     

胶原酶溶核术后疼痛加重患者硬膜外冲洗术治疗的疗效分析

目的:探讨硬膜外冲洗术在治疗腰椎间盘突出溶核术后疼痛中的疗效。方法:2004年3月~2010年12月,腰椎间盘胶原酶溶核术1652例中术后疼痛加重的170例患者,经保守脱水活血化瘀及营养神经治疗无明显缓解。术后一周至六周,患者给予硬膜外冲洗加注射消炎镇痛液治疗。结果:170例患者术后1周~6个月随访。术后6月疗效为优134例,良28例,差8例,优良率95.3%。其中104例行硬膜外冲洗术冲洗出混浊的溶解物。结论:硬膜外冲洗术可以减轻椎管内压力,是治疗腰椎间盘突出化学溶核术后疼痛加重的有效方法。     

下肢动脉硬化闭塞症误诊为腰椎间盘突出症25例原因分析

目的分析下肢动脉硬化闭塞症(arteriosclerosis obliterers,ASO)误诊为腰椎间盘突出症的原因及防范措施。方法对2008年8月—2013年10月收治的25例误诊为腰椎间盘突出症的下肢ASO的病例资料进行回顾性分析。结果本组表现为下肢疼痛15例,下肢麻木6例,下肢发凉4例;查体均发现足背、胫后动脉搏动消失。外院均诊断为腰椎间盘突出症,后经踝肱指数测定,结合下肢动脉彩色多普勒超声、计算机断层X线血管造影及磁共振血管造影确诊为下肢ASO。18例行经皮血管球囊扩张术及支架置入术,3例行杂交手术,2例行人工血管转流术,余2例仅予药物保守治疗,随访1年症状体征均明显缓解。结论临床医师应提高对下肢ASO的认识,认真详细询问病史及查体,重视临床资料的综合分析,以提高本病诊治水平。     

硬膜外腔联合用药治疗腰椎间盘突出症

BACKGROUND:Lumbardiscprotrusionwasasyndromeduetodegenerationofdisc,disruptionoffibrousringsandprotrusionofnucleuspulposusandstimulationofcaudaequina.Itwasthemostcommoncauseoflegandbackpain.ithadahighincidencerateandthepatientssufferedtoogreatlytonormalworkandlife.Afternon-operativetherapy,symptomsofmostpatientsdisappearedorrelieved.Only10%to15%ofthepatientsneededoperation.Re-cently,combinationdrugadministrationinepiduralspacewereusedinlumbardiscprotrusiontherapywithahighlysuccessfulrateand…     

Verlauf nicht operierter lumbaler Bandscheibenvorfälle

In Western industrial countries, low back pain is one of the most frequent causes of illness. Between the 4th and 5th decades of life approximately 80% of adults complain of low back pain, lasting for fairly long periods. About 10% of this population must undergo disc surgery once during life. Several authors have discribed good results for lumbar disc surgery in 55%-86% of their cases. Few control data are available, however, on patients with radiologically proven herniation of the disc regression, who were treated conservatively. Their observations indicate that regression of herniation of a lumbar disc is possible using conservative therapy exclusively. A study was therefore carried out on 43 patients with lumbar disc abnormalities, as demonstrated by spinal computed tomography (CT). Initially, 38 of them showed a herniation and 5 protrusion of the disc plus further neurological deficits and radicular pain syndromes. The subjects were followed up for over 20 months (mean) and monitored by CT in order to check the possibility that the CT findings, neurological deficits, and pain would regress a lengthy period of therapy. The results were the following: Initially, all patients complained of severe low back pain and sciatica, leading to subsequent treatment. At the time of follow-up, 15 of them still reported remittent or chronic low back pain, 9 remittent, and 16 chronic sciatic pain but of much less intensity. Before treatment, 40 patients had neurological deficits, whereas at the time of follow-up, only 24 patients still had deficits. In 2 patients the symptoms had not changed and in 2 others slight deterioration was observed. CT control examinations showed clear regression in the extent of disc herniation in 15 patients, in 18 a moderate decrease, and in 9 cases the CT findings had not changed. A favorable tendency towards regression was observed in disc herniations at the level of L5-S1 and in cases showing sequestration of the disc. Herniations of the disc at higher levels between L4-5 and L3-4 or a lateral herniation, reaching the intervertebral foramen, showed on unfavorable prognosis.