腰椎斜外侧椎间融合术后融合器沉降的原因分析

目的:观察斜外侧椎间融合(oblique lateral interbody fusion,OLIF)治疗腰椎病变术后融合器沉降现象,总结融合器沉降特点,并分析其原因,提出预防性措施。方法:回顾性分析2015年10月至2018年12月收治的144例腰椎病变资料,其中男43例,女101例;年龄20~81(60.90±10.06)岁;腰椎间盘退行性病变17例,巨大型腰椎间盘突出12例,椎间盘源性腰痛5例,腰椎管狭窄症33例,腰椎退行性滑脱26例,腰椎椎弓峡部裂伴椎体滑脱28例,腰椎内固定术后邻椎病11例,炎症转归期原发性椎间隙炎7例,腰椎退行性侧后凸5例。术前双能X线骨密度检查提示存在骨量减少或骨质疏松57例,骨密度正常87例。融合节段数:单节段124例,2节段11例,3节段8例,4节段1例。采用Stand-alone OLIF 40例,OLIF联合后路椎弓根螺钉固定104例。记录术后融合器沉降的发生情况,对可能风险因素进行单因素分析,观察融合器沉降对于临床结果的影响。结果:所有手术顺利完成,手术时间中位数99 min,术中出血量中位数106 ml;术中发生终板损伤30例,合并椎体骨折5例。所有患者获得随访,时间6~30(14.57±7.14)个月。随访过程中除原发性腰椎间隙炎病例、部分腰椎椎弓峡部裂伴椎体滑脱病例,其余出现不同程度的融合器沉降现象,其中正常沉降119例,异常沉降25例(Ⅰ级23例,Ⅱ级2例)。未出现椎弓根螺钉系统松动或断裂现象,椎间隙高度由术前的(9.48±1.84) mm恢复至术后3~5 d的(12.65±2.03) mm及末次随访时的 (10.51±1.81) mm,术后3~5 d与术前比较、末次随访与术后3~5 d比较差异均有统计学意义(P<0.05)。椎间融合率为94.4%(136/144)。腰痛和腿痛视觉模拟评分(visual analogue scale,VAS)分别由术前的(6.55±2.29)、(4.72±1.49)分降低至末次随访时的(1.40±0.82)、(0.60±0.03)分(P<0.000 1);ODI由术前的(38.50±6.98)%恢复至末次随访时的(11.30±3.27)%(P<0.05)。并发症发生率为31.3%(45/144),再手术率9.72%(14/144),其中因融合器沉降或移位而再次手术8例,占再手术的57.14%(8/14)。单因素分析结果显示:在骨量减少或骨质疏松组、Stand-alone OLIF组、2节段或以上融合组、终板损伤组中其异常沉降例数分别高于骨量正常组、OLIF联合椎弓根螺钉固定组、单节段融合组、终板无损伤组。结论:融合器沉降是OLIF术后较为常见的现象,术前骨量减少或骨质疏松、Stand-alone OLIF应用、2节段或以上融合和术中终板损伤可能是术后融合器沉降的重要因素。虽然融合器沉降程度与临床症状无明显相关,但存在融合器移位的风险,需要加强预防,以降低因融合器沉降而带来的严重并发症,包括再手术。     

Lumbar disc herniation in teenagers

Summary We report 48 patients operated on for lumbar disc herniation in the second decade of life (aged 13–20 years) in our Neurosurgical Division. To analyze the clinical and diagnostic features and surgical outcome of the disease in teenagers and to point out any differences from adults, we made a detailed study of over 900 juvenile cases and compared them with 11000 adult cases reported in the literature. Low-back pain proved to be less frequent among youngsters both as a first symptom and at diagnosis, while sensorimotor deficits have the same frequency in the two age groups. Herniation occurs more often at L4–L5 and is more frequently median among teenagers. The long-term surgical results in children and adolescents are better than in adults.     

Histochemical and ultrastructural observations on brown degeneration of human intervertebral disc

Thirty-eight fresh human intervertebral discs collected during anterior interbody fusion surgery were histochemically and ultrastructurally analyzed for pigments. Macroscopically, five stages of degeneration were classified according to the color, fibrosis, and fragility of the nucleus pulposus of the discs. In order to demonstrate lipofuscin granules, specimens were subjected to special staining procedures, including carbol fuchsin lipofuscin stain, the Schmorl's reaction, and autofluorescence. Lipofuscin granules were distributed from the inner layer of the annulus fibrosus to the nucleus pulposus. Such granules were numerous in cases of slight or severe degeneration, whereas fewer granules were found in cases of moderate degeneration. However, the stage of macroscopic degeneration of the intervertebral disc did not necessarily correlate with the incidence of lipofuscin granules. By ultrastructural observation, the morphological features of the components of the intervertebral disc and the ultrastructure of the lipofuscin granule were clarified. The ultrastructure of the "brown degeneration" disc exhibited markedly increased amorphous electron-dense bodies located among collagen fibrils in the matrix.     

针刺、自主牵引、药物外敷治疗腰椎间盘突出症疗效观察

目的 :观察针刺、自主牵引、药物外敷治疗腰椎间盘突出症 (简称治疗组 )的疗效。方法 :随机分为针刺、自主牵引、药物外敷组和单纯针刺组进行对比观察。结果 :治疗组总有效率 94 .1% ,明显高于对照组 75 .8% ,经统计学处理 ,P <0 .0 5 ,具有显著性差异。结论 :治疗组疗效优于对照组     

经椎板间隙入路显微内窥镜手术治疗腰椎间盘突出症

目的：探讨经椎板间隙入路显微内窥镜手术治疗腰椎间盘突出症的手术适应证，手术存在问题及解决方法。方法：用METRX治疗腰椎间盘突出症l16例，详细介绍手术过程、操作技巧、手术适应证和术中注意问题。结果；平均随访15．1个月，按Nakal疗效评定分级属优90例，良22例，可2例，差2例，优良率96．6％。结论：严格掌握手术适应证、准确定位、娴熟操作技巧、彻底止血、术后有计划的康复训练是手术成功的关键。     

"脊柱九针疗法"治疗腰椎间盘突出症40例

目的　观察采用“脊柱九针疗法”治疗腰椎间盘突出症的疗效。方法与结果　选择 4 0例经 CT检查确诊为腰椎间盘突出症 ,并有典型临床症状的患者作为研究对象 ,选用突出椎间盘的相应椎体及上下两个节段椎体棘突下和“夹脊穴”为主进针点 ,针刺治疗腰椎间盘突出症 ,总有效率为 10 0 %。结论　“脊柱九针疗法”较常规针刺取穴方法具有针对性强 ,针感强 ,疗效明显之特点 ,且取穴简便 ,操作简单安全。     

长圆针治疗继发性腰椎间盘脱出综合征1396例止痛疗效观察

目的:探讨治疗继发性腰椎间盘脱出综合征疼痛的新疗法.方法:将1396例继发性腰椎间盘脱出综合征患者用经筋辨证方法,循足三阴、三阳经筋查取结筋病灶点,采用长圆针以解结法治疗.结果:治愈(完全止痛)1145例,占81.7%;好转227例,占16.2%;无效29例,占2.1%.有效率97.9%.结论:长圆针治疗继发性腰椎间盘脱出综合征具有良好的止痛效应.     

Treatment of 97 cases of prolapse of lumbar intervertebral disc by manipulations of bone setting plus acupuncture

先应用改良斜扳法和旋转定位扳法对腰椎间盘突出症患者进行手法复位,然后取水沟和委中为主穴,进行针剌治疗.共治疗97例患者,治愈58例,好转35例,无效4例,总有效率95.9%.     

腰椎间盘退变动物模型的建立

目的　建立腰椎间盘退变的动物模型并行组织学和MRI观察。　方法　健康成年恒河猴 8只 ,手术组 6只 ,在其腰4 ,5、腰5,6、腰6,7椎间盘分别作一 5mm× 3mm切口 ,分别于术前及术后 1、4、8、13、2 0周对手术椎间盘行MRI观察 ;8只恒河猴分别于术前 (对照组 )及术后 4、8、2 0周随机取 2只处死后行椎间盘组织学观察。　结果　正常成年恒河猴腰椎间盘组织学结构特点与人类相似 ;手术椎间盘高信号区域面积的百分比于术后 8、13、2 0周显著减少 (P <0 0 5 ) ;术后 4周椎间盘切口外被纤维组织覆盖 ,术后 8周 ,切口外层纤维样愈合 ,其内无愈合迹象 ,术后 2 0周 ,切口向椎间盘内延伸 ,部分髓核出现纤维化。　结论　恒河猴是一种生理特性与人类相接近的动物 ,以其为对象应用纤维环切开法可以获得可靠的腰椎间盘退变动物模型 ;通过测量MRI轴位T2加权像椎间盘高信号区域面积百分比的方法可于早期无损伤地发现椎间盘退变。     

Acupuncture treatment of 32 cases of lumbar intervertebral disc protrusion

Yaoyangguan (GV 3), Shiqizhui (Ex-B 8) and Yanglingquan (GB 34) were selected as main points and a three-part needle insertion technique was used to treat 32 cases of lumbar intervertebral disc protrusion. The curative rate was 96.9%. Deep puncture is the key to the treatment. Author: Chen Feng(1962-), male, junior consultant doctor Translator: Wang Si-you