APLD配合中药治疗腰椎间盘突出症2003例疗效观察

自1997年6月～2003年6月,我院采用经皮穿刺髓核切吸术(APLD)配合中药治疗腰椎间盘突出症2003例,获得了满意的疗效.现总结报告如下.     

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.     

腰椎间盘突出切吸

本文报道了我院采用切吸仪(APLD) [2 ] 行腰椎间盘切吸术6 0 0例的体会。髓核切吸平均重量1.8g ,经1个月～12个月的随访,优良率2 0 0 0年以后达94 % ,2 0 0 0年以前90 %。经皮腰椎间盘切吸术是2 0世纪80年代在西方国家广泛应用于临床治疗腰椎间盘突出的新方法,据国内外多数报道,疗效满意,创伤小,痛苦少,费用低,时间短,一次性治疗率高,无严重并发症。笔者认为应严格选择适应证。精确定位下施术是非常重要的。     

自动经皮腰椎间盘切除术治疗腰椎间盘突出症伴骨化的体会

1985年Onik首先报道“自动经皮腰椎问盘切除术”(automated percutaneous lumbar discectomy,APLD)治疗腰椎问盘突出症以来,许多学分别进行了这项手术,多数报道疗效满意。1996年以来,我院采用国产电动式经皮椎问盘切吸仪治疗腰椎问盘突出症伴量化23例,效果满意,报告如下。     

Depletion of alloantigen-primed lymphocytes overcomes resistance to allogeneic bone marrow in mildly conditioned recipients

OBJECTIVE: Successful implantation of allogeneic bone marrow (BM) cells after nonmyeloablative conditioning would allow to compensate for the inadequate supply of compatible grafts and to reduce mortality of graft-vs.-host disease (GVHD). Recently, we proposed to facilitate engraftment of mismatched BM by conditioning for alloantigen-primed lymphocyte depletion (APLD) with cyclophosphamide (CY). Here we summarize the experimental results obtained by this approach. MATERIALS AND METHODS: Naive or mildly irradiated BALB/c mice were primed with C57BL/6 BM cells (day 0), treated with CY (day 1) to deplete alloantigen-primed lymphocytes, and given a second C57BL/6 BM transplant (day 2) for engraftment. Recipients were repeatedly tested for chimerism in the blood and followed for GVHD and survival. The protocol was also tested for inducing tolerance to donor tissue and organ allografts, and for treatment of leukemia, breast cancer, and autoimmune diabetes in NOD mice. RESULTS: APLD by 200 mg/kg CY provided engraftment of allogeneic BM from the same donor in 100% mildly irradiated recipients. Eighty percent chimeras remained GVHD-free more 200 days. All chimeras accepted permanently donor skin grafts and donor hematopoietic stromal progenitors. Allogeneic BM transplantation (BMT) after APLD had a strong therapeutic potential in BALB/c mice harboring malignant cells and in autoimmune NOD recipients. Tolerance-inducing CY dose could be reduced to 100 mg/kg. Conditioning for APLD resulted in engraftment of allogeneic BM after a significantly lower radiation dose than treatment with radiation and CY alone. CONCLUSION: Our results demonstrate that conditioning for APLD has a definite advantage over general immunosuppression with CY and radiation therapy.     

经皮穿刺双间隙髓核摘除术加胶原酶注射治疗复合型腰椎间盘突出症

目的:经皮穿刺双间隙髓核摘除术加胶原酶硬膜前间隙注射治疗复合型腰椎间盘突出症。方法:在C臂监控下,经皮穿刺,采用同一穿刺点,对相邻间盘切吸后,胶原酶注入硬膜前间隙。结果:治疗32例复合型腰椎间盘突出症,穿刺成功率为100%。结论:经皮穿刺双间隙髓核摘除术加胶原酶注射治疗腰椎间盘突出症,创伤小、恢复快,具有创新性。     

经皮穿刺切吸治疗腰椎椎间盘突出症的方法改进与体会(附40例报告)

报告了40例腰椎间盘突出症采用电动式经穿刺腰椎间盘切吸术(APLD),穿刺成功率100％。我们在体位训练、麻醉方法、进针角度等方面做了改进,严格地选择手术适应症。该方法不仅具有损伤小,并发症少,术后恢复快,不复发,有效率高等特点。还可保持腰椎原结构的完整性和稳定性,不会继发造成神经根的粘连及椎管的刺激性增生。病人可免除传统手术方法的痛苦,容易接受。效果确切而安全。     

APLD治疗腰椎间盘突出症远期疗效观察

目的　分析经皮穿刺腰椎间盘切吸术 (APL D)治疗腰椎间盘突出症远期疗效下降的原因并探讨相应处理措施。方法　通过 2年以上病例随访及回顾 ,观察比较近期、远期疗效。结果　随着时间延长 ,部分病例疗效下降。结论　术中摘取足够多的髓核组织及合理的术后康复锻炼是提高 APL D远期疗效的关键。对经 CT确诊为腰椎间盘突出症合并有腰椎管狭窄的患者 ,在予轴位牵引下直腿抬高试验检查后 ,对属可逆性腰椎间盘突出症患者 ,使用 APL D治疗后远期疗效满意     

经皮穿刺切吸治疗腰椎间盘突出症128例

报告１２８例腰椎间盘突出症采用电动式经皮穿刺腰椎间盘切吸仪治疗，穿刺成功率１００％。术后平均随访１０个月，优良率８０％。该方法具有创伤小，出血少，痛苦小，恢复快，不影响脊柱稳定性等优点。认为在诊断明确的基础上，严格选择适当征和正规操作，应用该方法是安全有效的。     

经皮穿刺切吸治疗腰椎间盘突出症102例报告

目的：本文报道了采用APLD技术行腰椎间盘突出髓核摘除术102例，研究APLD手术的适应症和禁忌症，APLD的特点和易出现的情况及并发症，以提高手术疗效。方法：利用有影像增强系统X线机，在透视下准确进入患病椎间盘内，用髓核切吸器连接输液器和负压吸引器，以300次／秒的速度反复切割抽吸髓核组织，随时观察吸出之髓核的颜色、性状及有无疤痕硬结块，充分切吸足够量的髓核后，退出髓核自动切吸器，令患者仰卧做直腿抬高试验，观察治疗效果。结果：本组102例术后随访3月－2年，优良率94％，2例无效经开放手术证实为根管狭窄、椎间盘碎块脱出游离于椎管，与术前诊断不清适应症选择不当有关。结论：APLD术有直接切吸髓核但不干扰椎管正常结构，具有创伤小、恢复快、住院时间短、术后痛苦少、护理简单、无严重并发症等优点，较开放手术容易被患者接受，是介于保守疗法和开放手术之间的一种补充方法。