经皮穿刺切吸术治疗伴钙化的腰椎间盘突出症35例体会

从１９９３年９月以来，我们使用ＡＰＬＤ技术治疗伴钙化的腰椎间盘突出症３５例，其中２８例获优良级疗效，４例可，３例差；随访３－１６个月，优良率８０％。我们体会到只要患者有间断性发作或近期内有中间缓解期病史，ＣＴ片显示间盘出阴影所占比例或成份大于钙化影时，则可使用经皮穿刺切吸技术，对经皮切吸治疗无效一般不宜进行二次切吸治疗，应选择手术治疗。     

低位腰椎间盘突出症的经皮切吸治疗

低位腰椎间盘突出症的经皮切吸治疗崇步伟，邵长余，张官智我们采用经皮髂骨钻孔穿刺切吸技术治疗低位腰椎间盘突出症１６例，均获成功。该技术较国外使用直的可弯曲的Ｎｕｃｌｅｏｔｏｍｅ探头绕过髂嵴进入低位椎间盘的做法更为优越。１６例中男１５例，女１例；年龄２５...     

切吸术联合臭氧注射治疗腰椎间盘突出症的效果观察

目的 探讨经皮椎间盘切吸术联合臭氧注射治疗腰椎间盘突出症的疗效及护理.方法 将50例腰椎间盘突出症患者随机分为对照组和观察组各25例,两组均采用经皮穿刺椎间盘切吸术,观察组在此基础上加置硬膜外导管注射臭氧.随访3个月观察疗效.结果 观察组治愈率(84.0%)显著高于对照组(52.0%,P＜0.05).结论 在切吸的同时置管注射臭氧可有效提高腰椎间盘突出症患者的治疗效果,掌握正确的操作方法是治疗成功的关键.     

腰椎间盘突出症再穿刺切吸原因探讨

1993年以来,我们应用APLD技术治疗腰椎间盘突出症358例,再穿刺切吸21例,再切吸率5.9%.分析原因有:术中操作不当3例,间盘切吸量不足10例,定位错误2例,双间盘突出漏切3例,间盘退变硬化4例.作者指出医源性因素是再切吸的主要原因.     

切吸术联合硬膜外注射治疗急重症神经根型腰椎间盘突出症

目的　通过对比经皮腰椎间盘切吸术及切吸术联合术中硬膜外药物注射治疗急重症神经根型腰椎间盘突出症的疗效 ,明确联合治疗的临床价值。方法　对有切吸术适应证的 79例急重症神经根型腰椎间盘突出症患者 ,依完全随机分组法 ,分为 A、B两组 ,A组 4 3例行单纯切吸术 ,B组 36例行切吸术联合术中硬膜外药物注射治疗 ,随访观察其临床效果。结果　随访 6— 18月单纯切吸术组 (A组 ) ,优良率 76 .7% ,联合治疗组 (B组 )优良率 88.9% ,两组优良率有显著差异性 (P〈0 .0 1)。结论　切吸术联合术中硬膜外药物注射治疗急重症神经根型腰椎间盘突出症 ,可作用互补 ,提高疗效 ,值得推广使用     

经皮穿刺切吸与臭氧射频组合应用治疗腰椎间盘突出症

目的 比较经皮穿刺椎间盘切吸术与该术式分别和臭氧氧化术、等离子射频消融术组合应用治疗腰椎间盘突出症的临床效果。方法 回顾性分析自2006-06-2012-06采用介入手术治疗的腰椎间盘突出症219例。其中经皮椎间盘切吸加臭氧氧化术55例（A组）,经皮椎间盘切吸加等离子低温射频术71例（B组）、单纯经皮椎间盘切吸术93例（C组）。结果 所有手术均顺利完成,随访1-7年,平均4年,采用视觉模拟评分法（VAS评分）、Oswestry功能障碍指数（ODI）评定疗效,经统计学分析：A、B组间差异无统计学意义（P〉0.05）,C组分别与A、B组间比较,差异有统计学意义（P〈0.05）。3组手术时间差异无统计学意义（P〉0.05）。结论 经皮穿刺椎间盘切吸术与臭氧氧化或等离子射频消融术组合使用可提高疗效。     

牵引下经皮腰椎间盘摘除术

目的 :介绍牵引下经皮腰椎间盘摘除技术治疗腰椎间盘突出症。方法 :采用胸髋牵引 ,C型臂X线机监视下行经皮腰椎间盘摘除 ,边牵引 ,边切吸 ,持续牵引 10～ 15min后 ,逐渐放松 ,可 2次牵引切吸。牵引重量为 3 0～ 5 0kg。结果 :本组 3 6例 ,髓核摘除量均值为 ( 2 .73± 0 .67)g ,1年以上随诊 2 8例 ,优良率达 96.4%。另外 ,我们曾在尸体腰椎上牵引穿刺 ,实验发现 ,穿刺针不易损伤神经根。结论 :我们认为牵引下经皮腰椎间盘摘除术安全、可靠 ,简单易行 ,可明显提高手术疗效。     

经皮腰椎间盘切吸369例分析

本文探讨了经皮腰椎间盘切吸术治疗腰椎向盘突出症的效果。通过对３６９ 例腰椎间盘突出症患者采用经皮腰椎间盘切吸治疗后随访：优良３５３ 例,占９５．７％ ,可与差１６ 例,占４．３％ 。作者认为该手术创伤小,恢复快,对椎管内无直接干扰。只要诊断准确,手术适应症选择合理、椎间盘切吸充分,就可以取得满意效果。     

双侧经皮穿刺椎间盘切吸术治疗腰椎间盘突出症

自１９９６年１月到１９９７年３月,我们将１０４例腰椎间盘突出症患者随机分为单侧经皮穿刺切吸组（Ａ组）、双侧经皮穿刺切吸组（Ｂ组）。随访６～１８个月,结果显示,双侧经皮穿刺椎间盘切吸术治疗腰椎间盘突出症的疗效优于单侧穿刺切吸术。１资料与方法１１临床资...     

切吸术联合臭氧注射治疗腰椎间盘突出症的效果观察

目的探讨经皮椎间盘切吸术联合臭氧注射治疗腰椎间盘突出症的疗效及护理。方法将50例腰椎间盘突出症患者随机分为对照组和观察组各25例，两组均采用经皮穿刺椎间盘切吸术，观察组在此基础上加置硬膜外导管注射臭氧。随访3个月观察疗效。结果观察组治愈率（84．0％）显著高于对照组（52．0％，P〈0．05）。结论在切吸的同时置管注射臭氧可有效提高腰椎间盘突出症患者的治疗效果，掌握正确的操作方法是治疗成功的关键。     

经皮穿刺切吸治疗腰椎间盘突出症

方法：本文通过１９６例腰椎间盘突出症的ＡＰＬＤ治疗及平均１２个月的临床观察,优良率达９５．４％,从适应症选择,禁忌症,髓核切吸量与疗效关系,再次切吸问题,并发症发生及预防措施等方面,详细论述了该技术运用中的一些具体问题。强调了伴有椎间盘钙化和椎体后缘骨赘形成时,仍可选择就诊前病史中有缓解期,本次发病不超过６个月的病例做为适应症。结论：认为该技术与保守治疗,传统手术一样,将成为治疗腰椎间盘突出症的主     

CT value analysis and clinical significance before and after percutaneous lumbar discectomy

OBJECTIVE: To provide theoretical basis for effect and mechanism of percutaneous lumbar discectomy in clinic. METHODS: A total of 180 patients with lumbar intervertebral disc herniation were evaluated by CT on the fifth day before and after operation. Meanwhile, CT value was measured in the determined level and region. RESULTS: After operation, CT value of the central and posterior determined point of herniated intervertebral disc was lower significantly than that before operation (P<0.01), but CT value of the anterior determined point was different insignificantly. The excellent and good results of the patients together were 83% postoperatively. CONCLUSIONS: The curative effect of percutaneous lumbar discectomy is achieved through reduction of lumbar intradiscal pressure.     

腰椎关节突关节不对称与腰椎间盘突出症术后复发的关联

目的探讨腰椎关节突关节不对称与腰椎间盘突出症术后复发是否有关联。方法收集25例腰椎间盘突出症术后复发患者,选出22例符合纳入标准作为复发组。选取24例行腰椎间盘髓核摘除术术后随访结果优良的患者作为对照组。分别由两名医师单独测量每组患者突出节段的关节突关节角度,双侧关节突关节角度差异〉10°的判断为不对称。行Kappa一致性分析评价两测量者对关节突不对称的判断差异,两组关节突关节不对称的病例数行χ2检验。并对复发组中关节突关节面方向与椎间盘突出方向关系进行分析。结果两测量者对关节突关节对称与否判断结果的一致性极佳;复发组关节突关节不对称病例数明显多于对照组,差异有统计学意义（P〈0.05）;关节突关节面方向与椎间盘术后再突出方向无关联（P〉0.05）。结论腰椎关节突关节不对称有可能是腰椎间盘突出术后复发的危险因素。     

显微椎间盘镜治疗腰椎间盘突出症疗效分析

目的通过后路显微内窥镜椎间盘摘除术的临床应用，探讨其技术要点和临床效果。方法对116例(143个间隙)腰椎间盘突出症患者施行后路显微内窥镜椎间盘摘除术。对其疗效进行回顾性分析。结果本组病人均在术后7d内出院。全组病人均获得随访，平均随访时间5．5个月，术后按Macnnab标准评级：优68例，良39例，可9例，优良率92．2％。结论后路显微内窥镜椎间盘摘除术手术创伤小，基本不影响脊柱稳定性，术后恢复快且疗效肯定。     

Microsurgery Versus Standard Removal of the Herniated Lumbar Disc: A 3-year Comparison in 150 Cases

The outcome of 150 patients with herniated lumbar disc treated by either microsurgical or standard discectomy were retrospectively reviewed after an average of 3 years. Both techniques provided satisfactory results, with 85 percent good or excellent outcome. Microsurgery gave less intraoperative bleeding, shorter hospitalization, and more rapid return to work. The main drawback was a higher recurrence rate of disc prolapse.     

Microsurgery Versus Standard Removal of the Herniated Lumbar Disc: A 3-year Comparison in 150 Cases

The outcome of 150 patients with herniated lumbar disc treated by either microsurgical or standard discectomy were retrospectively reviewed after an average of 3 years. Both techniques provided satisfactory results, with 85 percent good or excellent outcome. Microsurgery gave less intraoperative bleeding, shorter hospitalization, and more rapid return to work. The main drawback was a higher recurrence rate of disc prolapse.     

Microsurgery versus standard removal of the herniated lumbar disc. A 3-year comparison in 150 cases

The outcome of 150 patients with herniated lumbar disc treated by either microsurgical or standard discectomy were retrospectively reviewed after an average of 3 years. Both techniques provided satisfactory results, with 85 percent good or excellent outcome. Microsurgery gave less intraoperative bleeding, shorter hospitalization, and more rapid return to work. The main drawback was a higher recurrence rate of disc prolapse.     

Interlaminar discectomy and selective foraminotomy in lumbar disc herniation

Our objective was to assess the clinical outcome of interlaminar discectomy in patients suffering with degenerated lumbar disc lesions. We made a prospective study of 50 consecutive patients who underwent limited lumbar discectomy. The clinico-radiological parameters, type of surgery performed and the post-operative follow up were assessed. We found that interlaminar discectomy without laminotomy was adequate in 33 cases (66%). Most patients requiring laminotomy (17 cases -34%) for discectomy had associated lumbar canal stenosis, herniation at proximal levels (L3-4) and/or sacralization of L5 vertebra. Selective foraminotomy in addition to discectomy was performed in 28 cases (56%). The post-operative results were good in 43 (86%fair in 6 (12%) and poor subjective in 1 case (2%). No patient was classified as poor objective. In conclusion, interlaminar discectomy without laminotomy is a safe, effective and reliable surgical technique for treating properly selected patients with herniated lumbar disc at L4-5 and L5-S1 levels.     

椎管镜技术治疗腰椎间盘突出症并侧隐窝狭窄

目的 :探讨椎管镜技术治疗腰椎间盘突出症并侧隐窝狭窄的临床效果。方法 :采用显微内窥镜椎间盘切除系统治疗腰椎间盘突出症并侧隐窝狭窄 860例。结果 :临床疗效参照NaKai分级 ,70 9例获得随访 ,平均 2年 7个月 ,优 ,5 5 9例 ;良 ,12 7例 ;可 ,2 3例。结论 :椎管镜技术是治疗腰椎间盘疾病安全有效的方法 ,住院时间短 ,恢复快 ,但操作技术有待进一步提高。     

Comparison of chemonucleolysis and microsurgical discectomy for the treatment of herniated lumbar disc

A series of 126 patients with symptomatic herniated lumbar disc who were treated by either chemonucleolysis (CN) or microsurgical lumbar discectomy (MLD) was reviewed retrospectively. Of the 45 patients who chose chemonucleolysis, 27 (60%) reported a good outcome. The minor morbidity in this group was 52% and the major morbidity (infection) was 2.2%. Of the 81 patients who selected microsurgical discectomy, 72 (89%) reported a good result. The minor morbidity was 5%, and the major morbidity (infection) was 1.2%. The lower incidence of treatment success and higher percentage of patients suffering morbidity in the chemonucleolysis group make this procedure less desirable in the treatment of patients with herniated lumbar disc.