中医特色护理技术干预对腰椎间盘突出术后关节功能及生活质量的影响

目的:观察中医特色护理技术干预对腰椎间盘突出术后患者关节功能和生活质量的影响。方法:将86例腰椎间盘突出症术后患者随机分为2组,对照组43例给予常规护理干预,观察组43例在对照组的基础上联合中医特色护理技术进行干预;治疗2周后比较2组腰椎日本骨科协会(JOA)评分、疼痛视觉模拟评分法(VAS)评分以生活质量量表(QLQ-C30)评分。结果:治疗后,2组JOA评分较治疗前升高(P<0.05),疼痛VAS评分较治疗前降低(P<0.05),且观察组2项评分改善较对照组更显著(P<0.05)。干预后,观察组患者社会功能、躯体功能、心理功能、物质功能等各项QLQ-C30评分均明显高于对照组,差异均有统计学意义(P<0.05)。结论:中医特色护理技术干预能有效缓解腰椎间盘突出术后患者的疼痛,促进腰椎功能恢复,提高患者生活质量。     

展筋和血饮对腰椎后路椎体间融合术后患者疼痛及炎症因子的影响

目的:观察展筋和血饮对腰椎后路椎体间融合术术后疼痛、炎症因子的影响。方法:将60例腰椎后路椎体间融合术后患者按照随机数字表法分为对照组和治疗组,对照组给予抗感染、改善循环及腰椎功能康复锻炼治疗,治疗组在对照组基础上联合口服展筋和血饮治疗。比较两组视觉模拟评分法(VAS)评分及白细胞计数、中性粒细胞比率和C反应蛋白水平。结果:治疗7 d后,治疗组总有效率93.33%高于对照组的73.33%,差异有统计学意义(P<0.05)。治疗4、7 d后,两组VAS评分、白细胞计数、中性粒细胞比率和C反应蛋白较治疗前改善; 治疗4 d后,治疗组VAS评分、中性粒细胞比率、C反应蛋白水平低于对照组,差异有统计学意义(均P<0.05); 治疗7 d后,治疗组VAS评分、白细胞计数、中性粒细胞比率、C反应蛋白水平低于对照组,差异有统计学意义(均P<0.05)。结论:展筋和血饮有助于减轻腰椎后路椎体间融合术术后疼痛,抑制炎症反应,改善患者生活质量。     

试论医用臭氧治疗腰椎间盘突出症的中医学理论基础

詹红生教授认为“气虚痰瘀、络脉痹阻”是腰椎间盘突出的主要病机,治疗上应以补气为基本原则,并兼顾化痰散瘀。临床上,经皮椎间盘医用臭氧注射技术正是基于“补气理论”,通过局部“补气”以发挥气的推动和温煦作用,从而达到改善血运、促进炎性水肿和突出物吸收的目的。     

刺腰夹脊联合四指推脊柱调整手法对腰椎间盘突出症患者腰椎功能及疼痛程度的影响

目的:研究刺腰夹脊联合推拿(四指推脊柱调整手法)对腰椎间盘突出症(LDH)患者腰椎功能及疼痛程度的影响。方法:将100例LDH患者纳入研究。将其遵循随机信封法等分成联合组及对照组。对照组实施腰椎牵引联合常规推拿治疗,联合组则实施针刺腰夹脊联合推拿(四指推脊柱调整手法)治疗。评价两组疗效,治疗前后疼痛程度,治疗前后腰椎功能,治疗前后血清炎症因子水平。结果:联合组治疗总有效率优于对照组(P<0.05)。治疗后联合组及对照组的PRI评分均低于治疗前,且联合组低于对照组(均P<0.05)。治疗后联合组腰椎最大活动度及肌力正常百分比均高于对照组(均P<0.05)。治疗后联合组血清白细胞介素-1(IL-1)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平均低于对照组(均P<0.05)。结论:针刺腰夹脊联合推拿(四指推脊柱调整手法)可显著改善LDH患者腰椎功能,同时可减轻患者疼痛,缓解炎症反应,值得临床应用。     

脊柱定点旋转复位手法治疗对613例腰椎间盘突出症患者腰椎活动度及活动度对称性的影响

目的:观察脊柱定点旋转复位手法治疗对腰椎间盘突出症(LDH)患者腰椎活动度及活动度对称性的疗效。方法:选择被诊断为LDH的住院患者613例,给予脊柱定点旋转复位法为主的手法治疗,2次/周,共3周,分别在治疗前及1个疗程后观察LDH患者疼痛VAS评分,腰椎屈曲、背伸、左右侧旋、左右侧屈活动度以及左右侧屈和左右侧旋两侧对称性的变化。结果:手法治疗后,LDH患者的VAS评分显著下降(P<0.01),腰椎6个方向的活动度均显著改善(P<0.01),两侧侧屈和侧旋运动的关节活动度的对称性显著增加(P<0.01)。结论:腰椎的关节活动度以及两侧运动的对称性可作为评价脊柱手法疗效评价的客观量化指标。脊柱定点旋转复位法改善了腰椎关节的灵活性以及运动时的左右对称性,可促进脊柱力学平衡的恢复。     

Prevalence of adjacent segment disc degeneration in patients undergoing anterior cervical discectomy and fusion based on pre-operative MRI findings

Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical treatment for symptomatic cervical spondylosis. Some patients develop symptomatic adjacent segment degeneration, occasionally requiring further treatment. The cause and prevalence of adjacent segment degeneration and disease is unclear at present. Proponents for motion preserving surgery such as disc arthroplasty argue that this technique may decrease the “strain” on adjacent discs and thus decrease the incidence of symptomatic adjacent segment degeneration. The purpose of this study was to assess the pre-operative prevalence of adjacent segment degeneration in patients undergoing ACDF. A database review of three surgeons’ practice was carried out to identify patients who had undergone a one- or two-level ACDF for degenerative disc disease. Patients were excluded if they were operated on for recent trauma, had an inflammatory arthropathy (for example, rheumatoid arthritis), or had previous spine surgery. The pre-operative MRI of each patient was reviewed and graded using a standardised methodology. One hundred and six patient MRI studies were reviewed. All patients showed some evidence of intervertebral disc degeneration adjacent to the planned operative segment(s). Increased severity of disc degeneration was associated with increased age and operative level, but was not associated with sagittal alignment. Disc degeneration was more common at levels adjacent to the surgical level than at non-adjacent segments, and was more severe at the superior adjacent level compared with the inferior adjacent level. These findings support the theory that adjacent segment degeneration following ACDF is due in part to the natural history of cervical spondylosis.     

The use of polyurethane materials in the surgery of the spine: a review

Background contextThe spine contains intervertebral discs and the interspinous and longitudinal ligaments. These structures are elastomeric or viscoelastic in their mechanical properties and serve to allow and control the movement of the bony elements of the spine. The use of metallic or hard polymeric devices to replace the intervertebral discs and the creation of fusion masses to replace discs and/or vertebral bodies changes the load transfer characteristics of the spine and the range of motion of segments of the spine.PurposeThe purpose of the study was to survey the literature, regulatory information available on the Web, and industry-reported device development found on the Web to ascertain the usage and outcomes of the use of polyurethane polymers in the design and clinical use of devices for spine surgery.Study design/settingA systematic review of the available information from all sources concerning the subject materials' usage in spinal devices was conducted.MethodsA search of the peer-reviewed literature combining spinal surgery with polyurethane or specific types and trade names of medical polyurethanes was performed. Additionally, information available on the Food and Drug Administration Web site and for corporate Web sites was reviewed in an attempt to identify pertinent information.ResultsThe review captured devices that are in testing or have entered clinical practice that use elastomeric polyurethane polymers as disc replacements, dynamic stabilization of spinal movement, or motion limitation to relieve nerve root compression and pain and as complete a listing as possible of such devices that have been designed or tested but appear to no longer be pursued. This review summarizes the available information about the uses to which polyurethanes have been tested or are being used in spinal surgery.ConclusionsThe use of polyurethanes in medicine has expanded as modifications to the stability of the polymers in the physiological environment have been improved. The potential for the use of elastomeric materials to more closely match the mechanical properties of the structures being replaced and to maintain motion between spinal segments appears to hold promise. The published results from the use of the devices that are discussed show early success with these applications of elastomeric materials.     

Reliability of gadolinium-enhanced magnetic resonance imaging findings and their correlation with clinical outcome in patients with sciatica

Background contextGadolinium-enhanced magnetic resonance imaging (Gd-MRI) is often performed in the evaluation of patients with persistent sciatica after lumbar disc surgery. However, correlation between enhancement and clinical findings is debated, and limited data are available regarding the reliability of enhancement findings.PurposeTo evaluate the reliability of Gd-MRI findings and their correlation with clinical findings in patients with sciatica.Study designProspective observational evaluation of patients who were enrolled in a randomized trial with 1-year follow-up.Patients samplePatients with 6- to 12-week sciatica, who participated in a multicentre randomized clinical trial comparing an early surgery strategy with prolonged conservative care with surgery if needed. In total 204 patients underwent Gd-MRI at baseline and after 1 year.Outcome measuresPatients were assessed by means of the Roland Disability Questionnaire (RDQ) for sciatica, visual analog scale (VAS) for leg pain, and patient-reported perceived recovery at 1 year. Kappa coefficients were used to assess interobserver reliability.MethodsIn total, 204 patients underwent Gd-MRI at baseline and after 1 year. Magnetic resonance imaging findings were correlated to the outcome measures using the Mann-Whitney U test for continuous data and Fisher exact tests for categorical data.ResultsPoor-to-moderate agreement was observed regarding Gd enhancement of the herniated disc and compressed nerve root (kappa<0.41), which was in contrast with excellent interobserver agreement of the disc level of the herniated disc and compressed nerve root (kappa>0.95). Of the 59 patients with an enhancing herniated disc at 1 year, 86% reported recovery compared with 100% of the 12 patients with nonenhancing herniated discs (p=.34). Of the 12 patients with enhancement of the most affected nerve root at 1 year, 83% reported recovery compared with 85% of the 192 patients with no enhancement (p=.69). Patients with and without enhancing herniated discs or nerve roots at 1 year reported comparable outcomes on RDQ and VAS-leg pain.ConclusionsReliability of Gd-MRI findings was poor-to-moderate and no correlation was observed between enhancement and clinical findings at 1-year follow-up.     

经皮穿刺切吸与臭氧射频组合应用治疗腰椎间盘突出症

目的 比较经皮穿刺椎间盘切吸术与该术式分别和臭氧氧化术、等离子射频消融术组合应用治疗腰椎间盘突出症的临床效果。方法 回顾性分析自2006-06-2012-06采用介入手术治疗的腰椎间盘突出症219例。其中经皮椎间盘切吸加臭氧氧化术55例（A组）,经皮椎间盘切吸加等离子低温射频术71例（B组）、单纯经皮椎间盘切吸术93例（C组）。结果 所有手术均顺利完成,随访1-7年,平均4年,采用视觉模拟评分法（VAS评分）、Oswestry功能障碍指数（ODI）评定疗效,经统计学分析：A、B组间差异无统计学意义（P〉0.05）,C组分别与A、B组间比较,差异有统计学意义（P〈0.05）。3组手术时间差异无统计学意义（P〉0.05）。结论 经皮穿刺椎间盘切吸术与臭氧氧化或等离子射频消融术组合使用可提高疗效。