MR 对正常人及腰腿痛患者骶丛及坐骨神经的临床应用研究

1　材料和方法1 1　研究对象　正常人组 (对照组 )为随机抽样选择 30例 ,男 2 2例 ,女 8例 ,年龄 1 7～ 67(平均 40 2 )岁。既往无腰臀痛及腰骶椎、臀部软组织损伤史 ;神经科检查无阳性体征。腰腿痛患者组 41例 ,经临床手术病理证实具有不同程度的骶丛及坐骨神经病变者 ,男 2 9例 ,女 1 2例 ,年龄 2 1～ 64(平均48)岁 ,如表 1所示 :表 1　 41例患者病变分布 (例数 )ＭＲＩ扫描ＧＤ ＤＴＰＡ腰骶间盘突出 1 5-腰骶管术后神经粘连 52腰骶管内神经纤维瘤 55腰骶管内白血病浸润 2 2骶管内神经根旁囊肿 5-腰骶部脊索瘤 3 3腰骶骨巨细胞瘤 2 -腰…     

针罐结合治疗腰_5～骶_1棘间韧带损伤46例

笔者2009-08—2011-08应用针罐结合治疗腰5～骶1棘间韧带损伤46例,取得满意疗效,现报告如下。     

胶原酶溶盘治疗腰椎间盘突出症96例临床护理

2006年2月～2008年9月,我科采用胶原酶溶盘治疗腰椎间盘突出症96例,经精心护理,效果满意。现将护理体会报告如下。 1临床资料 本组96例,男60例,女36例;年龄21～58岁;病程15d～6年。左侧49例,右侧35例,双侧突出12例,其中腰4、5间盘突出54例,腰5骶1间盘突出38例,     

成人术后椎间隙感染及诊治

成人椎间隙感染多是腰椎间盘髓核摘除术后的并发症,临床较为少见,但却是一种严重的并发症。笔者自1985年～1997年间收治7例,结合文献复习,对其诊治认识报告如下: 1 临床资料 1.1 一般资料:本组7例,男5例,女2例,年龄41～52岁,平均46岁。腰_(4～5)椎间盘髓核摘除术6例,腰_5～骶_11例。椎板开窗5例,全椎板切除2例。腰_(4～5)椎间隙感染6例,腰_5～骶_11例。术后5天出现症状1例,14天出现症状2例,17天出现症     

提高L5/S1椎间盘穿刺成功率方法的探讨

目的探讨非钻孔法L5／S1椎间盘穿刺的有效方法，解决L5／S1椎间盘穿刺受髂骨阻挡的难题。方法①挺腹翘臀位穿刺法：腹部挺起，臀部后翘，以加大腰骶角使穿刺点上移；②盘缘穿刺法：穿刺针沿L5椎体后下角斜行进针到椎间盘中前1／3处，从而使穿刺点上移；③配合自制穿刺定位器对L5／S1椎间盘进行穿刺。结果运用该法穿刺L5／S1椎间盘280例全部成功，穿刺成功率100％。结论该法对L5／S1椎间盘穿刺效果理想，操作方便，具有较高的推广价值。     

逆行性连续骶管内麻醉112例

我院自1978年2月～1985年3月,对会阴区部分手术采用腰4～5或腰5～骶1间隙穿刺,尾端置管逆行注药连续骶管内阻滞麻醉,效果满意,现将资料完整的112例小结如下。     

旋转手法配合腰椎间孔穿刺注射治疗腰椎间盘突出症的临床观察

作者近年来采用旋转手法与腰椎间孔穿刺注射治疗腰椎间盘突出症 ,取得了满意的效果 ,现报告如下。1　临床资料本组 1 60例 ,男 1 0 9例 ,女 5 1例 ;年龄 1 7～62岁 ,病程 2ｄ～ 1 3年。腰 4～ 5椎间盘突出 89例 ,腰 5 -骶 1椎间盘突出 46例 ,腰 4～ 5和腰 5-骶 1合并突出 2 5例 ,其中棘突偏歪 1 0 8例 ,小关节半脱位 62例。所有患者均经Ｘ线腰椎正侧位片和ＣＴ或ＭＲＩ检查确诊。治疗组 :首先进行旋转手法 ,使偏歪棘突得到纠正 ,使关节突关节面对位 ;如遇个别患者腰肌板硬、剧痛不能配合者 ,可于旋转手法前肌注度冷丁5 0ｍｇ ,待手法结束后…     

腰池持续体外引流的护理体会

腰椎穿刺是神经外科常用的技术操作之一 ,主要用于脑外伤和颅脑、脊髓手术后放出血性脑脊液或鞘内注射药物治疗 ,往往需要反复穿刺 ,病人损伤和痛苦大 ,并且增加了感染机会。我们采用腰池体外引流的方法治疗 2 0例 ,取得了满意效果 ,现报告如下。1　临床资料与方法1 1　一般资料本组男 15例 ,女 5例 ,年龄 16～ 5 4岁 ,平均 36岁。其中创伤性蛛网膜下腔出血 12例 ,颅后窝肿瘤术后 4例 ,高血压性出血 2例 ,术后脑脊液皮漏 2例。1 2　治疗方法本组均在床边操作。严格无菌操作。选择腰 3～ 4、腰 4～ 5、或腰 5骶 1椎间隙为穿刺点 ,以腰 4～5为…     

中西医结合重手法复位治疗腰间盘脱出症191例分析

1991～2001年以来对临床诊断明确、比较典型的191例腰间盘脱出症患者采用中西医结合的方法在静脉麻醉下行重手法复位治疗，取得满意疗效。报道如下。 1临床资料 1．1一般资料 本组男118例，女73例；年龄16～65岁，其中31～50岁之前最多135例（占71％）；发病部位：腰3～4 5例（3％），腰4～5 138例（72％），腰5骶1 48例（25％）；     

腰椎间盘突出症手术效果不佳原因分析

近几年，我院采用椎板开窗、突出髓核摘除术治疗腰椎间盘突出症，绝大多数患蓄症状得到改善和恢复，但仍有少数患者术后症状持续存在，甚至加重。本文就疗效不佳的21例，结合临床资料进行分析。1临床资料1．1一般资料：本组男15例，女6例，年龄21～60岁，平均49．3岁。腰3，4突出1例，腰4．510例，腰5骶16例，腰4,5合并腰5骶14例。1．2临床表现：术前均表现为不同程度的腰腿痛，时间最长6年，最短1月，平均75月，直腿抬高小于30°者8例，小于60°者11例，大于60°者2例。术后腰腿痛无缓解4例（其中移行推1例，合并侧隐窝狭窄2例，神经很完全…     

经皮穿刺腰椎间盘切割术(附71例报告)

笔者分析71例经皮穿刺腰椎间盘切割术,总有效率93%,无严重并发症.并讨论了病例的选择、腰椎间盘膨出和腰5/骶1椎间盘脱出切割方法.     

老年腰椎间盘突出症患者介入治疗的随访研究

目的:回顾性分析介入治疗老年腰椎间盘突出症的疗效.方法:87例老年腰椎间盘突出症患者分为3组,均采用不同介入方法治疗,并进行6个月的随访.结果:总有效率95.4%,其中经皮腰椎间盘切除术(PLD组)有效率93.9%;化学溶核术(CNL组)96.3%;二者结合的双介入术(DIT组)96.4%,3组均无严重并发症发生.结论:介入治疗老年腰椎间盘突出症安全有效.双介入疗法的显效率优于单种治疗方法,对于双节段或单节段突出程度较重的老年患者宜采用双介入疗法.     

CT导引下腰5骶1脱出型椎间盘的胶原酶溶解术

目的 探讨腰5骶1脱出型椎间盘胶原酶溶解术的方法及其疗效。材料与方法 采用CT导引,经棘突旁、黄韧带、硬膜外间隙入路直接穿刺椎间盘髓核脱出部位,用1200单位胶原酶溶解脱出髓核。采用本方法治疗68例经临床确诊的腰5骶1脱出脱椎间盘病人,取得了良好的治疗效果。结果 68例病人用本方法治疗,治愈率为51．5％（35例）,有效率为92．6％（63例）,无严重并发症发生。结论 经CT导引硬膜外间隙入路直接穿刺脱出的髓核组织行胶原酶溶解术是一种安全、简便、疗效确切的方法,值得推广应用。     

Computed tomography diagnostic of the intervertebral disc degeneration and degenerative changes of the lumbo-sacral spine

Background. The aim of the work is problem of computed tomography diagnostic of the intervertebral disc degeneration and degenerative changes of the lumbo-sacral spine.
Authors present result of computed tomography examinations performed in 60 patients at the age from 18 to 69 years, suffering from chronic low back pain for 6 months at least.
Material and methods. Degenerative changes of the vertebra-disc junction on the levels of L3-L4, L4-L5 and L5-S1 were evaluated. The analysis of intervertebral disc changes and osteophytes presence on all of the investigated levels was chose as the assessment criterion.
Results. The pathological changes of the vertebra-disc junction on L5-S1, L4-L5 and L3-L4 levels were stated in 58 (96.6%), 55 (91.6%) and 47 (78.8%) patients, whereas the degeneration of the intervertebral disc was diagnosed in 50, 45 and 15 cases, respectively. Moreover, the vacuum phenomenon was present in connection with the degeneration of the intervertebral disc on L5-S1, L5-L4, L3-L4 levels in 29, 11 and 1 cases, respectively. The osteophytes' presence, as a single proof of the degenerative changes was diagnosed in 8 patients on L5-S1 level, whereas on L4-L5 level in 10 patients. In 32 cases osteophytes were localised on L3-L4 level.
Conclusions. In conclusion, the differences in morphology of the pathological changes are the result of different loading and various mechanisms generating these changes on particular levels.     

Schmerzen und Funktionsstörungen der Lendenwirbelsäule bei lumbalen Bandscheibenvorfällen

In this study we attempted to explore the correlation between lumbar disc herniation and functional disorders of the lumbar spine. Fifty patients with lumbar disc herniation proven by computed tomography underwent a comprehensive functional, neurological and radiological examination. All patients were compared to a control group consisting of 16 healthy subjects of comparable age. Only patients without signs of bone or soft tissue alterations or pregnancy at the time of examination were included into the study. Herniations of the L4-5 disc showed a dysfunction in the same segment in 64% of the cases. There was also a correlation between this segmental dysfunction and pain in the sacrotuberal and iliolumbar ligaments. All patients with segmental dysfunction felt pain in the dorsal ligaments. If there was no segmental dysfunction pain in the dorsal ligaments was encountered just as often as in the control group. Herniations of the L5-S1 disc had a dysfunction in the same segment in only 12% of the cases, but in 35% there was dysfunction of the L4-5 motion segment. In this group pain in the dorsal ligaments did not correlate with segmental movements. Frequency of ligamental pain in L4-5 herniations was equal to that in L5-S1 herniations. With increasing size of the disc herniation, the frequency of segmental dysfunction, paralysis and loss of reflexes also increased, but the pain in the dorsal ligament decreased.Segmental dysfunction is explained by increased muscular tone being provoked by irritation of the sinuvertebral nerve. The differences between L4-5 and L5-S1 movements are probably due to the different functional anatomy of these segments. Ligamental pain may be explained by the fact that these ligaments have the same insertion and the muscles have increased in tone.     

CT介入靶位注射胶原酶治疗腰椎间盘突出症

目的:探讨CT介入靶位注射胶原酶治疗腰椎间盘突出症的临床应用价值。方法:198例接受注射胶原酶溶盘术的腰椎间盘突出症患者分为非CT组（100例）和CT组（98例）,非CT组依据腰椎CT片和腰椎定位片定位,凭经验操作;CT组在CT介入下定位和操作。结果:CT组的优良率和有效率分别为84.7％和94.9％,较非CT组分别提高了12.7％和8.9％,经X2检验,p值均<0.05。结论:CT介入下靶位注射胶原酶溶盘术,直观,安全,可提高术前诊断的准确性和术中穿刺的精确性,从而可提高临床疗效。     

New minimally invasive discectomy technique through the interlaminar space using a percutaneous endoscope

INTRODUCTION: The serial dilating technique used to access herniated discs at the L5-S1 space using percutaneous endoscopic discectomy (PED) via an 8 mm skin incision can possibly injure the S1 nerve root. In this paper, we describe in detail a new surgical procedure to safely access the disc and to avoid the nerve root damage. This small-incision endoscopic technique, small-incision microendoscopic discectomy (sMED), mimics microendoscopic discectomy and applies PED. MATERIALS AND SURGICAL TECHNIQUE: The sMED approach is similar to the well-established microendoscopic discectomy technique. To secure the surgical field, a duckbill-type PED cannula is used. Following laminotomy of L5 using a high-speed drill, the ligamentum flavum is partially removed using the Kerrison rongeur. Using the curved nerve root retractor, the S1 nerve root is gradually and gently moved caudally. Following the compete retraction of the S1 nerve root to the caudal side of the herniated nucleus pulposus (HNP), the nerve root is retracted safely medially and caudally using the bill side of the duckbill PED cannula. Next, using the HNP rongeur for PED, the HNP is removed piece by piece until the nerve root is decompressed. A total of 30 patients with HNP at the L5-S1 level underwent sMED. In all cases, HNP was successfully removed and patients showed improvement following surgery. Only one patient complained of moderate radiculopathy at the final visit. No complications were encountered. DISCUSSION: We introduced a minimally invasive technique to safely remove HNP at the L5-S1 level. sMED is possibly the least invasive technique for HNP removal at the L5-S1 level.     

经皮腰椎间盘髓核摘除术适应症的选择

目的：进一步探讨经皮腰椎间盘髓核摘除术（ＰＬＤ）适应症的选择。方法：对８９例１００个间隙ＰＬＤ术后患者进行分析。３８例３个月,２３例１２个月疗效观察。结果：合理使用ＰＬＤ技术,严格掌握适应症,治疗优良率明显提高,可达９０％。结论：经临床及ＣＴ明确诊断的椎间盘突出、而无椎间盘组织脱落椎管等并发症,保守治疗无效的病例可首先选用ＰＬＤ技术。     

Prevalence of Radiographic Findings in Individuals With Chronic Low Back Pain Screened for a Randomized Controlled Trial: Secondary Analysis and Clinical Implications

ObjectiveThe purpose of this study is to measure the prevalence of graded disc degeneration, spondylolisthesis, transitional segmentation, and the distribution of sacral slope in patients 21 to 65 years of age with chronic low back pain (CLBP).MethodsThis retrospective study analyzed 247 digital lumbar radiographic series obtained during a randomized controlled trial of chiropractic patients with CLBP. Chronic low back pain was defined as pain in the low back lasting 12 weeks or longer. Radiographic findings of disc degeneration, spondylolisthesis, and lumbosacral transitional segmentation were graded by 2 authors using established classification criteria. Sacral slope was measured with a digital tool contained within imaging software.ResultsLumbosacral transitional segments graded I to IV (Castellvi classification) were present in 14% of cases. Lumbar disc degeneration was most prevalent at L3-4 (49%), followed by L4-5 (42%), L2-3 (41%), L5-S1 (37%), and L1-2 (29%). Isthmic spondylolisthesis was present in 5% of cases, with L5 the most common location. Degenerative spondylolisthesis demonstrated a prevalence of 18%, most commonly occurring at L4. The prevalence of degenerative spondylolisthesis was 51% for women aged 50 to 59 years and 24% for men in the same age range.ConclusionsModerate-severe disc degeneration, multilevel disc narrowing, and degenerative spondylolisthesis were common in individuals with CLBP with age more than 40 years. Isthmic spondylolisthesis was not more prevalent than what has been reported in other populations. Transitional segmentation was identified in a minority of participants, with some of these exhibiting accessory joints or fusion. Mean sacral slope in individuals with CLBP was not substantially different from mean slopes reported in other populations.     

Schmerzen und Funktionsstörungen des Iliosakralgelenks bei Bandscheibenvorfällen der unteren Lendenwirbelsäule

Back and leg pain in patients with lumbar disc herniation can be caused by various mechanisms. In addition to nerve root compression, functional alterations in the sacroiliac joint, facet joint or the iliolumbar and sacrotuberal ligaments can produce "pseudoradicular" lower back syndrome. The following study attempts to show whether or not pain and functional alterations in the sacroiliac joint (SIJ) correlate with herniations revealed by computed tomography (CT). The study also attempts to determine the correlation between pain and functional changes of the SIJ and the size and level of the disc herniation. Fifty patients with monosegmental disc herniations revealed by CT who showed no signs of bone or soft tissue alterations were included in this study. The average duration of the patients' complaints of leg or back pain was 5.7 years. Ninety-six percent of these patients had received conservative treatment before admission to our hospital. All patients were compared to a control group consisting of 16 healthy subjects of comparable age. All patients underwent a comprehensive functional, neurologic and radiologic examination. The CTs were analyzed by a standardized three-dimensional method. All of the 50 patients had sciatica complaints and a disc herniation revealed by CT. In two cases hemiation of the L3-4 disc was demonstrated, in 14 cases L4-5 disc herniation and in 34 cases a L5-S1 disc herniation. In contrast to the control group of 15 healthy subjects, the patients showed a significant number of functional disorders upon examination. In 84% of all patients, movement of the SIJ was restricted. Painful palpation of the symphysis was demonstrated in 46% of all cases. Thirty-five percent of patients with herniation of L4-5 disc demonstrated SIJ tenderness as opposed to 65% of the patients with herniation of the L5-S1 disc. This SIJ tenderness did not correlate with motion of the SIJ. In addition, SIJ motion and frequency of sensory dysfunction showed no correlation with the size of the disc herniation. Paralysis and loss of reflexes showed a positive correlation with the increasing size of the disc herniation. SIJ tenderness decreased as the size of the herniation increased. Dysfunction of the ipsilateral SIJ is explained by increased muscular tone caused by irritation of the n. sinuvertebralis and its lumbar coupling. Frequency of SIJ tenderness is significantly higher in patients with herniations between L5 and S1. Since the SIJ is innervated by the r. dorsalis of the sacral roots, the increased tenderness can be explained by the change in neurovegetative innervation of the SIJ. Due to the high correlation between lumbar disc herniation and SIJ dysfunction, disc herniation should be considered as a possible cause of sacroiliac-joint syndrome.