CT导向下医疗用臭氧治疗腰椎间盘突出症

目的观察CT导向下医用臭氧治疗腰椎间盘突出症的疗效。方法30例腰椎间盘突出症患者,术前均经CT或MRI检查证实。在CT导向下行臭氧消融治疗。盘内注入浓度为60μg/ml臭氧10-20 ml,退针出纤维环至椎间孔附近,注入浓度为40μg/ml臭氧5 ml。结果随访时间1-6个月,显效7例,有效18例,无效5例,总有效率为80.3%,未发生任何明显并发症。结论CT导向下医用臭氧局部注射是治疗腰椎间盘突出症的一种有效方法。     

胸腰椎病变CT监视下穿刺活检路径分析

目的探讨胸腰椎病变CT监视下穿刺活检中穿刺路径的选择方法。方法141例胸腰椎病变临床诊断不清患者，其中胸椎70例，腰椎71例。根据病变位于脊椎的不同部位选择合适的穿刺路径，于CT监视下穿刺取材。穿刺路径：经椎旁路径63例，经椎弓根路径45例，经肋椎关节路径11例，其他路径22例。结果141例中共有128例诊断正确，穿刺结果诊断正确率为90．8％。无并发症发生。结论胸腰椎病变穿刺路径的选择要根据病变的位置不同具体分析。总的原则是安全、取材量多、对患者损伤小。     

改良应用股骨髓腔绞刀行腰椎椎间植骨融合术

目的探讨应用普通股骨髓腔扩大绞刀代替专用的椎间植骨器械,进行腰椎后路椎间植骨融合术的临床经验体会,评估治疗效果。方法对我院34例应用股骨髓腔绞刀进行腰椎后路椎间植骨融合术的病例资料,进行回顾性分析。结果本组34例无围手术期硬膜及神经根损伤,无伤感染和和植骨块松脱。随访5～6年,植骨全部于6～8个月愈合,无一例植骨塌陷。按Machnab标准评定：优21例,良11例,可2例,差0例,优良率94.12%。结论改良应用股骨髓腔扩大绞刀代替专用的椎间植骨器械,作椎间植骨床的准备,效果满意,安全方便。     

Nonoperatively treated burst fractures of the thoracic and lumbar spine in adults: a 23- to 41-year follow-up

BACKGROUND CONTEXT: Several studies report a favorable short-term outcome after nonoperatively treated two-column thoracic or lumbar burst fractures in patients without neurological deficits. Few reports have described the long-term clinical and radiological outcome after these fractures, and none have, to our knowledge, specifically evaluated the long-term outcome of the discs adjacent to the fractured vertebra, often damaged at injury and possibly at an increased risk of height reduction and degeneration with subsequent chronic back pain. PURPOSE: To evaluate the long-term clinical and radiological outcome after nonoperatively treated thoracic or lumbar burst fractures in adults, with special attention to posttraumatic radiological disc height reduction. STUDY DESIGN: Case series. PATIENT SAMPLE: Sixteen men with a mean age of 31 years (range, 19-44) and 11 women with a mean age of 40 years (range, 23-61) had sustained a thoracic or lumbar burst fracture during the years 1965 to 1973. Four had sustained a burst fracture Denis type A, 18 a Denis type B, 1 a Denis type C, and 4 a Denis type E. Seven of these patients had neurological deficits at injury, all retrospectively classified as Frankel D. OUTCOME MEASURES: The clinical outcome was evaluated subjectively with Oswestry score and questions regarding work capacity and objectively with the Frankel scale. The radiological outcome was evaluated with measurements of local kyphosis over the fractured segment, ratios of anterior and posterior vertebral body heights, adjacent disc heights, pedicle widths, sagittal width of the spinal canal, and lateral and anteroposterior displacement. METHODS: From the radiographical archives of an emergency hospital, all patients with a nonoperatively treated thoracic or lumbar burst fracture during the years 1965 to 1973 were registered. The fracture type, localization, primary treatment, and outcome were evaluated from the old radiographs, referrals, and reports. Twenty-seven individuals were clinically and radiologically evaluated a mean of 27 years (range, 23-41) after the injury. RESULTS: At follow-up, 21 former patients reported no or minimal back pain or disability (Oswestry Score mean 4; range, 0-16), whereas 6 former patients (of whom 3 were classified as Frankel D at baseline) reported moderate or severe disability (Oswestry Score mean 39; range, 26-54). Six former patients were classified as Frankel D, and the rest as Frankel E. Local kyphosis had increased by a mean of 3 degrees (p<.05), whereas the discs adjacent to the fractured vertebrae remained unchanged in height during the follow-up. CONCLUSIONS: Nonoperatively treated burst fractures of the thoracic or lumbar spine in adults with or without minor neurological deficits have a predominantly favorable long-term outcome, and there seems to be no increased risk for subsequent disc height reduction in the adjacent discs.     

通用型脊柱内固定系统(GSS)在腰椎不稳症治疗中的近期疗效观察

目的 :观察GSS对腰椎节段性不稳的固定及治疗效果。方法 :2 0 0 2年 10月～ 2 0 0 3年 9月 ,对 2 5例腰椎不稳症患者。其中 ,男 9例 ,女 16例 ,运用椎板减压、椎管后外侧植骨融合、GSS椎弓根螺钉内固定系统治疗 ,随访 6～ 18个月 (平均 15 7个月 )。结果 :术前JOA评分平均 4 48分的 2 5例患者 ,随访时 14 5分 (P <0 0 1) ,术后 14个月内动态X线检查显示GSS椎弓根螺钉固定患者植骨融合率 10 0 % ,融合节段稳定 ,临床症状改善优良率 96 0 %。结论 :后路运用GSS行椎管后外侧植骨融合内固定对腰椎不稳症患者是一种安全、有效的术式 ,近期疗效满意     

Ⅰ期前后路联合手术治疗严重下颈椎骨折脱位

[目的]探讨Ⅰ期前后路联合手术固定在严重下颈椎骨折脱位中的临床疗效和应用价值。[方法]采用颈椎前路钢板和后路侧块钉棒Ⅰ期联合复位内固定技术治疗严重下颈椎骨折脱位27例,手术均在颅骨牵引下经鼻腔气管插管全身麻醉下进行,先采用俯卧位,植入侧块螺钉、减压、复位后,植入棒,运用“弓弦原理”,采用CD旋棒技术恢复颈椎的序列,维持并稍加大颈椎在矢状面上的生理前凸,植骨融合后拆除颅骨牵引置仰卧位,行前路椎体复位、减压、植骨及自锁钛板固定。术后定期复查X线片以观察损伤节段的稳定性和融合率,以Frankel分级判定脊髓功能的恢复情况。[结果]术后27例全部获得随访,随访6~27个月,平均11.6个月。脱位均完全复位,无植骨不融合。损伤节段稳定,颈椎椎间高度及生理曲度都得到良好重建及维持,未出现内固定断裂、松动及脱出,无血管、神经、食道损伤等并发症。除5例A级、2例B级脊髓功能无恢复,Frankel分级无变化外,其余Frankel分级平均提高1.8级,其中5例患者达到E级。[结论]颈椎Ⅰ期前后路联合手术固定治疗严重下颈椎骨折脱位,完全恢复颈椎序列,复位良好,椎管前后方压迫得到彻底解除,损伤节段术后获得即刻稳定,方便术后护理和功能锻炼,有利于脊髓功能恢复,为一积极有效的方法。     

经皮等离子消融髓核成形术治疗腰椎间盘突出症: 28例随访报告

目的 探讨腰椎间盘突出症的治疗方法。方法经体格检查，CT和／或MRI检查确诊的腰椎间盘突出症患者28例，采用等离子消融髓核成形术治疗，以Prolo功能和经济结果评定法和VAS评分评定疗效。结果髓核成形组总体治疗成功率82．1％；平均住院时间7．6天，复发率10．8％。并发椎间盘炎1例，进行腰椎融合术后治愈。结论髓核成形术治疗腰椎间盘突出症的满意率较高，复发率低，住院治疗时间短，创伤小，不影响再次手术治疗。髓核成形术是一种安全、有效的治疗腰椎间盘突出症的微创介入治疗新方法。     

椎间盘镜系统治疗腰椎间盘突出症550例

目的探讨椎间盘镜系统治疗腰椎间盘突出症的疗效. 方法改进部分手术器械,采用膝胸坐位,穿刺黄韧带进入椎管等方法,应用METRx进行腰椎间盘取出术550例. 结果随访6～36个月,平均21个月,疗效参考Nakai标准,优478例 (86.9%),良60例(10.9%),可6例(1.1%),差6例(1.1%).疗效差6例再次镜下扩大侧隐窝清理残留髓核疗效转良. 结论 METRx下行腰椎间盘取出术,创伤小、安全、疗效好,值得推广.     

椎弓根固定结合椎体成形术治疗胸腰椎爆裂骨折

目的探讨椎弓根固定结合经椎弓根椎体内植骨行椎体成形术治疗胸腰椎爆裂骨折的疗效。方法采用椎管环形减压、短节段椎弓根螺钉系统固定结合经椎弓根椎体内植骨治疗胸腰椎爆裂骨折116例,其中93例获得随访。术前及术后随访行X线和CT检查,测量伤椎椎体中央高度值,比较植骨后椎体高度的恢复程度,同时观察植骨融合情况。采用配对t检验方法进行统计学分析。结果93例患者术后平均随访24.2个月,90%以上患者伤椎椎体高度恢复并维持良好,无塌陷。伤椎椎体中央高度值犤T12(3.14±0.41)cm,L1(3.33±0.34)cm犦与正常值犤(T12(3.26±0.38)cm,L1(3.47±0.61)cm)犦比较,差异无显著性意义(P>0.05)。未出现植骨操作引起的神经血管并发症。CT显示椎体内植骨块边缘模糊,融合良好,植骨块无吸收现象。结论后路椎管环形减压及内固定时,经伤椎椎弓根进行椎体内植骨行椎体成形术可恢复伤椎椎体高度,重建前、中柱的稳定性,预防术后椎体塌陷的发生。     

Unusual course of an epidural rhabdomyosarcoma of the upper thoracic spine

Summary This report deals with a case of rhabdomyosarcoma in the upper thoracic spine. It is of particular interest, not only for the rarity of type and location of this tumour, but for its clinical course, which presented fluctuations of neurological status, included an acute demonstration of complete paraplegia followed by full recovery after conservative treatment, and gradual relapsing of neurological deficit, one year later.