B超诊断腰椎间盘突出症的临床价值(附64例分析)

报告经CT检查和临床治疗证实的64倒腰椎间盘突出症的B超检查结果,B超检出70个突出之椎间盘,CT检出73个,阳性率之比为70/73。70个突出椎间盘中,中央型5个,偏中央型20个,后外侧型44个,极外侧型1个;轻度30个,中度28个,重度12个。分型分度与临床表现及治疗选择有密切关系。B超检查与CT相此较,具有近似的诊断价值,但经济、实用,操作简单方便,值得推广。     

颈椎前路钢板椎间融合器系统治疗颈椎间盘突出症

颈椎前路手术在颈椎间盘疾病中已广泛应用，手术方法主要为颈前路减压加椎间植骨融合术。但不管是早期的自体骨融合的颈前路手术，还是后来进一步发展的颈前路钢板以及椎间融合器技术，都存在着诸如融合失败率高、植骨块移位、塌陷、螺钉断裂、钢板松动等并发症，造成手术疗效不佳以致于二次手术。自2002年2月-2004年1月采用颈椎间盘摘除、颈椎前路钢板椎间融合器（PCB）系统内固定、植骨融合术治疗颈椎间盘突出症后均无前述并发症的发生，疗效满意，现报道如下。     

侧后方潜式减压术治疗下胸段椎间盘突出症

自1996年6月-2000年6月,共收治下胸段椎间盘突出症的病人16例,均行侧后方潜式减压髓核摘除术,效果满意,报告如下.     

Gd-DTPA-enhanced MR in thoracic disc herniations

Summary The Gd-DTPA-enhanced magnetic resonance findings in two patients with herniated thoracic intervertebral discs are reported. The first patient was a 56-year-old woman with a small subligamentous T6-7 disc herniation, slightly lateralized to the right. The second patient was a 51-year-old man with a central and right posterolateral disc herniation, including a large calcified fragment, at the T8-9 level. The nonenhanced MR examination revealed the presence of an extradural mass lesion in both patients, impinging upon the dural sac and compressing and displacing the spinal cord posteriorly. The lesion was slightly hypointense on both T1- and T2-weighted spin echo sequences. Following intravenous injection of Gd-DTPA in a dosage of 0.1 mmol/kg body weight, enhancement of the posterior longitudinal ligament was noted and triangular areas of contrast uptake were seen to occur in the epidural space above and below the herniated disc. At surgery, they were found to correspond to dilated and congested epidural veins.     

Erb:YAG and Hol:YAG laser ablation of meniscus and intervertebral discs.

Erb:YAG and Hol:YAG laser ablation rates of fibrocartilage and nucleus pulposus were measured in vitro simulating clinical conditions. After ablation macroscopic and microscopic appearance of the ablation site was investigated. Hol:YAG and Erb:YAG laser mean ablation rates increased almost linearly with rising energies, showing higher total ablation rates for the Hol:YAG laser due to its higher achievable energy density. At comparable energy densities the Erb:YAG laser appears to be more effective with respect to the corresponding ablation rates. Consequently, the ablational threshold proved to be lower for the Erb:YAG laser. Whereas during Hol:YAG laser ablation, some smoke formation and considerable tissue shrinking occurred, these effects could not be observed during Erb:YAG laser ablation. Consequently macroscopic and microscopic inspection showed some thermal damage after Hol:YAG and only minimal alterations after Erb:YAG laser ablation. Adjacent thermal damage was determined and proved to be lower for the Erb:YAG laser. In our opinion the characteristics of each laser system provide certain advantages for special clinical indications.     

Fracture separation of the articular pillar of C5 following brass knuckles trauma

We report the case of a fracture separation of the articular pillar at the lower cervical spine. The trauma, following a brass knuckles, repeats almost in an experimental way the rotation and extension mechanism given in literature for the genesis of such injuries. From the admission in the orthopaedic service to the surgery, the development went in a characteristic way towards a rotatory displacement. Received: 12 July 2002, Accepted: 18 August 2002 Correspondence to: R. Massicot     

仿生髓核组织工程材料支架对体外培养髓核细胞合成代谢的影响

目的：观察自行设计构建的仿生髓核组织工程材料——CⅡ／HyA-CS（CHCS）支架对体外培养髓核细胞合成代谢的影响。方法：将体外培养的传1代髓核细胞接种于培养瓶内，置入CHCS支架，体外培养10d后，分别测定^3H-脯氨酸掺入量、培养液中糖胺聚糖（GAG）含量、髓核细胞可凝集蛋白多糖（Aggrecan）、核多糖（Decorin）、二聚糖（Biglycan）的mRNA表达及Aggrecan的蛋白表达等。结果：实验组与对照组的^3H-脯氨酸掺入量、培养液中GAG含量、髓核细胞Aggrecan、Decorin、Biglycan mRNA表达、Aggrecan蛋白表达等均无统计学差异。结论：CHCS支架对体外培养髓核细胞的合成代谢无明显抑制作用。     

退变腰椎间盘髓核细胞立体培养与单层培养的生物活性比较

目的：比较体外单层培养和旋转微载体立体培养人退变腰椎间盘髓核细胞的生物学活性指标,探讨更加有效的椎间盘髓核细胞体外培养方法.方法：对获取的腰椎间盘突出症患者的24个椎间盘按年龄分为A组（20～25 岁）、B组（26～30 岁）、C组（36～45 岁）及D组（＞45岁）,分别利用酶消化法进行单层细胞培养和旋转微载体立体培养系统进行立体培养,观察细胞生长形态,检测细胞生长曲线及速度、细胞生长活性、细胞分裂指数及胶原含量.结果：单层培养的髓核细胞贴壁后为多角形或梭形,伸出伪足;立体培养的细胞在微载体上呈梭形或不规则形,呈立体状生长.立体培养的细胞生长速度较快,1周内两种培养方法各时间点及各组间比较均具有统计学意义（P＜0.05）.立体培养的髓核细胞活性提高,随年龄增加细胞活性下降;指数生长期细胞分裂指数与单层培养相比有统计学意义（P＜0.05）;Ⅰ、Ⅱ型胶原含量与单层培养相比有统计学意义（P＜0.05）,A组分别与B组、C组及D组比较均有统计学意义（P＜0.05）.结论：旋转立体培养人退变椎间盘髓核细胞的活性保持良好,较单层培养能够大量、优质收集种子细胞,可用于椎间盘组织工程中种子细胞的研究.     

手法为主综合治疗腰椎间盘突出手术后复发

腰椎间盘突出症所引起的腰腿痛,目前多主张以保守治疗为主,但经手术治疗的也有一定比率。自2000年10月-2005年12月共收治经手术后复发的腰椎间盘突出症19例,临床应用松肌法、分离神经根粘连法、骨盆旋转整脊法、后伸压腰法、纠正脊柱侧弯法为主,结合骨盆牵引中药熏蒸,药物对症治疗为辅,取得了满意的效果。为探究其疗效机制,现总结如下。1临床资料1.1一般资料19例中,男16例,女3例;年龄26~59岁。有劳损、外伤及受凉诱发者12例。发病部位据CT、MRI检查统计:L3,4椎间盘突出1例,L4,5椎间盘突出9例,L5S1椎间盘突出5例,L4,5和L5S1两节段椎间盘…     

腰椎间盘膨出CT诊断标准的探讨

在经椎间盘中心平面的ＣＴ扫描图像上，对下腰段８２个正常椎间盘（男４９个，女３３个）及相应平面后方之硬胶囊、椎管的矢径、横径和面积进行了测量，并用指数形式来表示前、后二者间各项指标的比例关系。通过与４０个（男２７个、女１３个）膨出椎间盘的比较分析，发现硬膜囊面积／椎间盘面积、硬膜囊矢径／椎间盘矢径及椎管矢径／椎间盘矢径等三个指数在椎间盘膨出的诊断中最有价值。