Posterior endoscopic discectomy: Results in 300 patients

Background:

Posterior endoscopic discectomy is an established method for treatment of lumbar disc herniation. Many studies have not been reported in literature for lumbar discectomy by Destandau Endospine System. We report a series of 300 patients operated for lumbar dissectomy by Destandau Endospine system.

Materials and Methods:

A total of 300 patients suffering from lumbar disc herniations were operated between January 2002 and December 2008. All patients were operated as day care procedure. Technique comprised localization of symptomatic level followed by insertion of an endospine system devise through a 15 mm skin and fascial incision. Endoscopic discectomy is then carried out by conventional micro disc surgery instruments by minimal invasive route. The results were evaluated by Macnab''s criteria after a minimum followup of 12 months and maximum up to 24 months.

Results:

Based on modified Macnab''s criteria, 90% patients had excellent to good, 8% had fair, and 2% had poor results. The complications observed were discitis and dural tear in five patients each and nerve root injury in two patients. 90% patients were able to return to light and sedentary work with an average delay of 3 weeks and normal physical activities after 2 months.

Conclusion:

Edoscopic discectomy provides a safe and minimal access corridor for lumbar discectomy. The technique also allows early postoperative mobilization and faster return to work.     

Maitland手法结合牵引推拿TDP治疗神经根型颈椎病的临床研究

目的观察Maitland手法结合牵引、推拿、特定电磁波辐射仪(TDP)治疗神经根型颈椎病(cervical spondylotic radicu-lopathy,CSR)的临床疗效和安全性。方法采用随机对照临床试验的方法,将146例CSR患者分为治疗组、对照A组和对照B组进行3个疗程(30 d)的治疗观察。治疗组采用Maitland手法、牵引、推拿、TDP疗法治疗,对照A组采用推拿、牵引、TDP疗法治疗,对照B组采用牵引、TDP疗法治疗。比较3组临床疗效及疼痛评分、颈椎功能评分改善情况。结果治疗结束时,治疗组、对照A组和对照B组的总有效率分别为97.9%、85.7%和65.3%;1个月后随访,3组的总有效率分别为93.7%,77.6%和57.1%;治疗组的总有效率优于对照A组和对照B组(均P0.01)。治疗组疼痛评分差值和颈椎评分差值分别为4.5±1.5和10.4±3.5,对照A组的分别为3.2±1.9和7.6±2.9,对照B组的分别为2.4±1.5和5.2±2.9,治疗组的疼痛评分差值和颈椎评分差值优于对照A组和对照B组(均P0.01)。结论 Maitland手法结合牵引、推拿和TDP治疗CSR具有一定临床时效性、科学性,值得推广。     

中药配合牵引治疗神经根型颈椎病疗效观察

目的：观察中药结合牵引治疗神经根型颈椎病的临床疗效。方法：将96例神经根型颈椎病患者随机分为两组,口服中药结合牵引治疗组50例,单纯牵引对照组46例。两组均于治疗两个疗程（4周）后行疗效评定。结果：治疗组总有效率为92%,对照组78.3%。经统计学分析,两组比较差异有统计学意义（P〈0.05）。治疗组的疗效明显优于对照组。结论：中药结合牵引治疗神经根型颈椎病有确切疗效。     

颈腰止痛药配针刺治疗神经根型颈椎病的临床观察

[目的] 观察颈腰止痛药配合针刺治疗神经根型颈椎病的临床疗效和安全性.[方法]将200例患者随机分为试验组和对照组各100例,分别用颈腰止痛药加针灸、根痛平加针灸治疗,疗程均为20d;观察两组临床疗效及治疗前后中医证候积分的变化情况.[结果] 治疗组总有效率为91.00%,对照组总有效率为86.00%,组间疗效比较无显著性差异(P＜0.05);治疗组在改善中医证候、疼痛记分及握力方面明显优于对照组(P＜0.05).[结论] 颈腰止痛药可明显改善神经根型颈椎病的临床症状、中医证候,且无毒副作用.     

A comparison of thermography and electromyography in the diagnosis of cervical radiculopathy

We studied 20 asymptomatic control subjects and 14 patients with clinically unequivocal cervical radiculopathy to compare the diagnostic value of thermography with that of electromyography. We measured the average skin temperature of designated regions over the neck, shoulder, and upper extremities. We then compared the temperature between corresponding regions of the two limbs, and between fingers innervated by different roots in the same hand. Thermography was abnormal in 6 patients (43%), whereas electromyography was abnormal in 10 (71%). Thermographic abnormalities were seen only in the hands and fingers, and the pattern did not follow the dermatome of the clinically involved cervical root. When compared to electromyography, thermography provided no additional diagnostic information. Thus, thermography does not have an established role in the evaluation of patients with cervical radiculopathy.     

针刺治疗神经根型颈椎病临床研究进展

神经根型颈椎病是颈椎病中最常见类型。近年来其发病率呈上升趋势,严重危害人类健康。本文着重从针灸治疗神经根型颈椎病的随机对照试验方面,探讨各种针法的疗效比较以及与其他治疗方法联合运用的效果,为进一步深入研究提供参考。     

Adductor T reflex abnormalities in patients with decreased patellar reflexes

The adductor reflex (AR) is a tendon reflex that has various features that differ from other tendon reflexes. This reflex was tested in different disorders presenting with diminished patellar reflexes such as diabetic lumbosacral radiculoplexus neuropathy (DLRPN), L2–L4 radiculopathy, and distal symmetric diabetic neuropathy (diabetic PNP). The AR and crossed‐AR (elicited by tapping the contralateral patellar tendon) were recorded using concentric needle electrodes. Additionally, the patellar T reflex (vm‐TR) and vastus medialis H reflex (vm‐HR) were recorded using surface electrodes. AR was recorded in only one out of eight patients with DLRPN, but it was recorded in 21 out of 22 patients with L2–L4 radiculopathy (95.5%). Of these reflexes, only AR showed prolonged latency in the L2–L4 radiculopathy group. The latencies of AR, vm‐TR, and vm‐HR were prolonged in patients with diabetic PNP. We conclude that AR can be useful in the differential diagnosis of some lower motor neuron disorders that present with patellar reflex disturbance. Muscle Nerve 40: 264–270, 2009     

颈肩部压痛的测定及其在神经根型颈椎病诊疗过程中的意义

目的评价应用人体压痛力学定量测试仪测定颈肩部压痛方法及其对旋提手法疗效的意义。方法本组神经根型颈椎病患者210例（脱落12例）,其中试验组106例（脱落5例）,对照组104例（脱落7例）。治疗方法试验组采用旋提手法,对照组采用牵引疗法,应用人体压痛力学定量测试仪于治疗前和治疗后第1、3、5、7、9、11、13天及治疗后1个月随访8个时间点测量颈肩部压痛。结果210例患者常见压痛点有棘突旁、肩胛骨上角、斜方肌颈肩移行部、肩胛骨内侧缘等。第3、4、5、6、7次复诊和1月随访试验组颈肩部压痛缓解优于对照组（P〈0.05或P〈0.01）。结论人体压痛力学定量测试仪有利于压痛的量化评定,旋提手法可明显减轻神经根型颈椎病患者的颈肩部压痛。