计算机体层成像多平面重建在评价椎间融合中的作用

目的 探讨计算机体层成像多平面重建(CTMPR)在评价椎间融合中的作用,寻找定量评价椎间融合的新方法.方法 13例行腰椎间融合的患者术后1周、3个月、6个月行CTMPR,行椎间融合器(Cage)内植骨CT值定量测量.结果 术后1周Cage内植骨CT值为(619.52±26.97)Hu,术后3个月为(628.69±42.60)Hu,术后6个月为(657.77±37.43)Hu.术后1周与术后3个月相比无显著性差异,与术后6个月相比有显著性差异.结论 CT值的测量在椎间融合的判断中具有高准确性.     

A comparative study of the anatomical,radiological and therapeutic features of the lumbar facet joints

Summary An anatomical study of the lumbar apophyseal joints was carried out to facilitate recognition of facet joint lesions, which we now examine routinely by percutaneous arthrography. Special attention was given to the configuration of the different compartments of the joint space and to its relationships with the contents of the intervertebral foramen. The abnormalities seen on lumbar facet joint arthrography are very varied; two major groups should be stressed: synovial fringe hypertrophy and pseudodiverticular synovial ectasia. The percutaneous approach to lumbar facet joint arthrography allows it to be used a therapeutic measure, with injection of anti-inflammatory drugs into the joint space, the beneficial effects of which were confirmed in our series. The precision, efficiency and cost-effectiveness of this outpatient technique justify and should encourage its more widespread application in the diagnosis and treatment of low back pain.     

影像设备引导下经皮穿刺与支气管填塞治疗耐多药肺结核空洞的疗效分析

目的评价影像设备引导下,经皮穿刺与经支气管填塞,治疗耐多药肺结核空洞的临床疗效。方法CR、CT及生化,病理学确诊的耐多药肺结核空洞患者88例,用经皮穿刺治疗44例(A组)和经支气管填塞治疗44例(B组)。并对照分析其方法,并发症和疗效,评估其应用价值。结果A组闭塞性空洞愈合14例(32%)、净化性空洞愈合16例(36%),无变化及轻微缩小14例(32%),总治愈率为68%;B组闭塞性空洞愈合23例(52.27%),净化空洞愈合17例(38.64%),无变化及轻微变小4例(9%),总治愈率达91%。B组比A组总疗效高出23%(91%~68%),并发症低,疗程缩短1~2个月。结论支气管填塞治疗耐多药肺结核空洞的疗效要优于经皮穿刺的方法。是目前治疗耐多药肺结核空洞的比较有效方法。     

经皮穿刺腰椎间盘切吸术治疗腰椎间盘突出症的远期疗效

目的 观察X线电视引导下经皮穿刺腰椎间盘切吸术治疗腰椎间盘突出症的远期疗效。方法 32例经CT扫描证实的腰椎间盘突出症患者，其中，膨出型29例，游离型2例，以及突出型1例，均经X线电视引导下经皮穿刺腰椎间盘切吸术治疗，术后均经随访0.5～11.0a。结果 术后1周～3个月，32例中的24例临床症状与体征得到有效控制或明显减轻，随访5～11a观察表明，症状完全消失和明显减轻者分别见于23例和6例，总有效率90.6%，预后极好和较好者均见于膨出型腰椎间盘突出症患者。结论 游离型和突出型腰椎间盘突出症的疗效均不理想，因此，术前认真选择适应证是获得理想疗效的关键性因素。     

腰穿术后平卧方法的临床观察

目的 通过腰穿术后病人平卧方法舒适度的临床观察比较,从而探讨选择术后最佳的平卧方法.方法 观察并记录2001-02～2006-09的1070例门诊腰穿术后病人,2种平卧方法(即去枕仰卧位和低枕卧位)的舒适度.结果 随机分2组2种平卧方法临床观察,低枕卧位明显优于去枕仰卧位.结论 腰穿术后低枕卧位方法的选择对病人术后的尽快恢复,有较好的帮助.     

The role of JOA score as an indication for surgical or conservative treatment of symptomatic degenerative lumbar spinal stenosis

Abstract The aim of this study was to evaluate the short- to medium-term results (up to 2 years) of conservative and surgical treatments of patients with symptomatic lumbar stenosis. To our knowledge, no previous study has provided strict indications for conservative or surgical treatment. We retrospectively studied 184 patients, who were divided into 3 groups according to JOA (Japanese Orthopaedic Association) score. A cutoff JOA score was arbitrarily fixed at 7. Patients with a score ≤7 (n=12; group A) underwent surgery, while patients with a score >7 (n=172) were conservatively treated. Group A included patients surgically treated within two months from diagnosis. Group B consisted of 144 patients who received conservative treatment, while group C (28 patients) represented patients who underwent surgery after a period of failed conservative treatment. The outcomes of surgical and conservative treatments were evaluated after 12 and 24 months, and were rated as satisfactory, not totally satisfactory, not satisfactory or totally unsatisfactory. Conservative treatment consisted of physical, orthotic and drug therapy, whereas surgical treatment included spinal decompression and instrumentation (if indicated), either rigidly or dynamically performed. Surgery was indicated in 22% of all patients and we obtained excellent results in 85% of them. Operative treatment provides excellent results for patients with severe clinical presentation (JOA score ≤7), while individuals with mild to moderate spinal stenosis (JOA score >7) should receive conservative treatment.     

显微椎间盘镜治疗腰椎间盘突出症

目的探讨显微内镜腰椎间盘切除术(microendoscopy discectomy,MED)治疗腰椎间盘突出症的疗效. 方法回顾分析MED治疗59例腰椎间盘突出症的临床资料,总结经验教训. 结果 59例随访4～24个月,平均15个月,按Macnab评定标准,优43例,良14例,可1例,差1例,术后出现神经功能障碍,优良率96.6%(57/59). 结论 MED是包容性腰椎间盘突出症的首先治疗方法,严格掌握手术适应证及提高手术技巧是MED成功的关键.     

改良经后路椎体间融合术治疗腰椎滑脱症

目的探讨单枚Cage加自体骨块椎间融合的改良经后路椎体间融合(PLIF)治疗腰椎滑脱症的疗效。方法自2000年12月～2006年6月,笔者在椎弓根螺钉系统复位固定的基础上用1枚Cage加1块自体骨椎间融合的手术方法治疗腰椎滑脱症46例,崩裂性滑脱24例,退变性滑脱22例。其中男25例,女21例;年龄29～67岁。部位:L3、42例,L4、523例,L5S121例。根据Meyerding滑移分度法:Ⅰ度22例,Ⅱ度19例,Ⅲ度5例。结果随访8～72个月,平均25个月。根据Nakai疗效评定标准:优23例,良22例,可1例。术后滑脱复位44例,Ⅲ度恢复到Ⅰ度2例。结论Cage加自体骨块融合的改良PLIF手术治疗腰椎滑脱症,具有固定坚强、较好维持椎间高度、良好的椎间骨融合、疗效确实等优点。     

L4椎管内骨软骨瘤致神经根受压1例报告

患者，男，62岁。2002年3月初开始，无明显外伤史，逐渐出现腰痛伴一侧腿痛4年余，时轻时重，经对症治疗有好转而没有引起重视。近半年腰腿痛症状加重，伴典型间歇性跛行，站立和行走时症状加重，而下蹲或坐下休息和卧床时减轻，疼痛从左侧臀部放射至同侧小腿外侧与足背。门诊以腰椎管狭窄收入院。检查：腰部无畸形，L4棘突与棘突左侧压痛，腰部过伸试验阳性。