经皮髓核钳夹术联合臭氧治疗腰椎间盘突出症的应用研究

目的 探讨经皮髓核钳夹术(PLD)联合医用臭氧(O3)注射治疗腰椎间盘突出症后O3在椎间盘内外弥散、突出物回缩情况以及临床效果、不良反应、并发症等.方法 选择通过影像检查(CT或MR)结合临床确诊为腰椎间盘突出症的120例患者,按随机数字表法分为3组(PLD组、O3注射组、PLD+O3注射组),每组各40例,分别按方案实施治疗.结果 PLD+O3注射组腰痛发生率最低,O3在椎间盘内外弥散最好;突出物回缩率3组间无明显差异;PLD+O3注射组术后立即有效率为86%,PLD组为83%,O3注射组为35%;随访6～18个月,PLD+O3注射组总有效率为92.5%,PLD组为87.5%,O3注射组为77.5%;3组均未发生并发症.结论 PLD联合O3注射治疗腰椎间盘突出症是一种较好的综合治疗方案,安全、有效,可提高治疗效果,减少不良反应.     

DSA下臭氧治疗腰椎间盘突出症的护理

我院2006年5月～2006年12月，应用医用臭氧注射治疗腰椎间盘突出症20例,护理体会如下。l.对象与方法 男12例，女8例；年龄24～65岁。椎间盘膨出8例，突出10例,脱出2例。材料：GELCV-PLUS血管造影机，医用纯氧,医用臭氧发生器。后外侧入路采用22G酒精针,小关节内侧入路采用24 G 9cm穿刺针。     

医用臭氧治疗腰椎间盘突出症长期疗效分析

目的 评价经皮椎间盘内臭氧注射治疗腰椎间盘突出症的长期疗效. 方法回顾性分析南方医科大学珠江医院影像中心及南方医院介入治疗科自2002年7月至2004年3月应用臭氧治疗的324例腰椎间盘突出症患者的临床资料.所有患者均随访≥3年,比较术前和最后随访时日本骨科学会(JOA)评分及下肢根性痛的视觉模拟评分(VAS);运用改良的MacNab分级法记录最后随访的临床效果并评价患者年龄、病史长短、突出程度及类型等因素对治疗效果的影响. 结果本组患者JOA评分、下肢根性痛VAS术前及术后终末随访时比较差异均有统计学意义(6.3±1.4 vs 13.1±1.2,P=0.018;7.5±0.8 vs 2.1±0.3,P=0.039),JOA评分、VAS改善率分别为78.2%和70.4%;改良的MacNab分级法记录到最后随访时疗效优良率为77.5%(251/324),患者年龄、病程及椎间盘突出程度对疗效有明显影响;部分(33.8%)包含型突出患者治疗后近期可有症状"反跳".结论 臭氧治疗腰椎间盘突出症术后3年以上随访结果显示疗效令人满意,患者年龄、病程和椎间盘突出程度能影响患者疗效.     

医用臭氧治疗腰椎间盘突出症长期疗效分析

Objective To evaluate the leng-term effect ofpercutaneous ozone injection into the intervertebral space for treatment of lumbar disc herniation. Methods A retrospective analysis of the clinical data was performed in 324 patients with lumbar disc herniation admitted in Zhujiang Hospital and Nanfang Hospital, Southern Medical University between April, 2000 and March, 2004. All the patients were treated with percutaneous ozone injection into the intervertebral space and followed up for no less than 3 years. The scores of the Japanese Orthopedics Association (JOA) and sciatica Visual Analog Scales (VAS) before and at the end of the follow-up were recorded and compared. The modified MacNab criteria were adopted for evaluation of the effect of the treatment. The patients' age, disease course, severity of disc herniation and type of herniation were also analyzed in relation to the therapeutic effect. Results Compared with the scores recorded before the operation, the average scores of JOA and VAS increased significantly at the end of the follow-up (6.3±1.4 vs 13.1±1.2 for JOA, P=0.0178;7.5±0.8 vs 2.1±0.3 for VAS, P=0.039), with JOA and VAS improvement rates of 78.2% and 70.4%, respectively. According to modified MacNab criteria, good therapeutic effect was achieved in 77.5% (251/234) of the cases, the patients' age, the disease course and severity of disc herniation showed significant impact on the therapeutic effect. More than one third of the patients (33.8%) with herniation of inclusion type experienced symptom relapse early after the treatment. Conclusion The 3-year follow-up data show that ozone treatment produces satisfactory long-term effect on lumbar disc herniation. The patient's age, disease course and severity of herniation are three important factors that affect the long-term therapeutic effect.     

CT引导下经皮臭氧髓核溶解术治疗150例腰椎间盘突出症疗效分析

目的分析CT引导下经皮臭氧髓核溶解术治疗150例腰椎间盘突出症的疗效。方法在CT引导下,经L2～S1椎间隙,用21 G穿刺针插入椎间盘突出区后,注入中等浓度(50～60μg/mL)臭氧5～10 mL。结果一次进针成功率85%。穿刺途径采用腰椎后侧方35°～45°经安全三角区进入椎间盘。经过随访,效果优良132例,效果差18例,优良率92.5%。结论经皮臭氧溶解术治疗腰椎间盘突出症创伤小、安全性高,近期疗效有较大价值。     

椎间盘镜治疗腰椎间盘突出症

目的 探讨椎间盘镜手术系统（ＭＥＤⅡ）治疗腰椎间盘突出症的临床应用及适应症。方法 采用ＭＥＤⅡ技术进行髓核除及神经根管减压术。结果 本组治疗腰椎间盘突出症７５例,随访６￣１２个月,按ＮａＫａｉ标准评定：优５９例,良１２例,可３例,差１例。结论 ＭＥＤⅡ能充分显示硬脊膜,神经根及突出的髓核组织,手术安全,减压充分,创伤小,保持了脊柱后柱完整性与稳定性。适用于单节段腰椎间盘突出症或合并相同节段神经根     

PLDD联合胶原酶溶核术治疗腰椎间盘突出症

介入治疗是腰椎间盘突出症重要治疗方法之一,因其操作简便,痛苦小,恢复快,并发症少,故患者容易接受。自2010年3月至2011年3月运用经皮激光汽化椎间盘减压术(percutaneous laser disc decompression,PLDD)联合胶原酶溶核术治疗腰椎间盘突出症216例,疗效满意。     

经皮腰椎间盘摘除术治疗腰椎间盘突出症62例探讨

目的探讨经皮腰椎间盘摘除术(PLD)在腰椎间盘突出症治疗中的临床应用。方法采用PLD技术在DSA监控下行经皮腰椎间盘摘除术。结果62例患者均达到了治疗效果,其中60例全愈,22例术后短期内出现症状“反跳”,经治疗后症状消失;结论PLD手术的有效率达90%以上,并发症发生率几乎为零,为一安全、有效的治疗手段。     

腰椎间盘突出症的治疗进展

腰椎间盘突出的治疗方法大致分为保守治疗和手术治疗二类。保守治疗有卧床休息、牵引、理疗、全身及局部药物治疗。手术治疗有传统的后路全椎板或半椎板切除腰椎间盘摘除术、椎板间开窗腰椎间盘摘除术及前路腰椎间盘摘除术。有借助穿刺针、显微镜、腹腔镜及椎间盘镜进行的腰椎间盘摘除术。腰椎间盘摘除后或行椎间融合或行人工椎间盘置换。本文就以上问题进行综述     

后路椎间盘镜治疗腰椎间盘突出症33例临床观察

腰椎间盘突出症过去主要是保守治疗和传统手术，近几年微创手术的开展，改变了传统脊柱外科技术的面貌。自2004-03-2005-08，我院应用后路椎间盘镜髓核摘除系统（MED）治疗腰椎间盘突出症33例，创伤小、恢复快、出血少，效果理想。报告如下。     

显微内窥镜下腰椎间盘摘除和传统开放手术治疗腰椎间盘突出症的

背景：显微内窥镜手术系统将传统开放手术和显微内镜技术相结合,将传统的髓核摘除内镜化、微创化。与传统开放手术相比,显微内窥镜腰椎间盘摘除可放大手术野、有良好的照明系统,术者视野更清晰,操作更为精细,对周围组织的损伤也较小。 目的：对显微内窥镜下腰椎间盘摘除和传统开放手术治疗腰椎间盘突出症的疗效及临床价值进行评价。 方法：按照Cochrane系统评价的方法,计算机检索Medline(1990-01/2010-03)、Embase(1990-01/2010-03)、Cochrane图书馆及中国生物医学数据库(1990-01/2010-03),并采用手工检索等方法收集会议文献。文献检索无语种限制。收集所有相关随机对照试验,采用Cochrane协作网提供的软件Revman 5.0进行Meta分析,以获得显微内窥镜下腰椎间盘摘除和开放手术治疗腰椎间盘突出症的疗效是否有差异的相关证据。 结果与结论：共纳入12个研究,包括1 748例腰椎间盘突出症患者。进行Meta分析结果显示,显微内窥镜手术的操作时间与传统开放手术无明显差异,但在术中出血量、术后卧床时间和住院时间上优于传统开放手术。提示显微内窥镜手术是一种治疗腰椎间盘突出症理想的微创手术方式。     

Percutaneous endoscopic lumbar discectomy for lumbar disc herniation

This study aims to compare the advantages and disadvantage of percutaneous endoscopic lumbar discectomy (PELD) and standard discectomy (SD) for the treatment of lumbar intervertebral disc herniation (LDH). We searched in MEDLINE, EMBASE, PubMed, Web of Science and Cochrane databases for relevant trials that compare PELD and SD for the treatment of LDH. The Cochrane Collaboration’s Revman 5.3 software was used for data analyses. This meta-analysis compiled 1301 cases from four random controlled trials and three retrospective studies. Compared with SD, PELD showed a shorter operative time (mean difference (MD) = −18.68, 95% confidence interval (CI): −24.92 to −12.43; p < 0.00001), less blood loss (MD = −64.88, 95% CI: −114.51 to −15.25, p < 0.0001), shorter hospital stay (MD = −3.51, 95% CI: −4.93 to −2.08, p < 0.00001), and shorter mean disability period (MD = −34.34, 95% CI: −53.90 to −14.77, p < 0.006). However, there were no significant differences in the visual analogue scale (VAS) scores at the final follow up (MD = −0.23, 95% CI: −0.53 to 0.07, p = 0.14), Macnab criteria at the final follow up (MD = 1.04, 95% CI: 0.72 to 1.50, p = 0.82), complications (RR = 0.76, 95% CI: 0.40 to 1.43, p = 0.39), recurrence rate (risk ratio (RR) = 1.00, 95% CI: 0.61 to 1.64, p = 1) and reoperation rate (RR = 1.40, 95% CI: 0.90 to 2.16, p = 0.13). In conclusion, despite PELD showing significant benefit in short term outcomes such as hospital course and mean disability period, similar clinical efficacy and long term outcomes were observed when compared to SD. Therefore, we suggest that PELD can be a feasible alternative to the conventional posterior approach for the LDH depending on surgeon preference and indication. High-quality randomized controlled trials with sufficient large sample sizes necessary further confirm these results.     

经皮脊柱内镜下手术治疗腰5-骶1椎间盘突出症

目的 探讨经皮脊柱内镜下手术治疗腰5-骶1椎间盘突出症的方法及效果。方法 回顾性分析2013年3月至2016年1月经皮脊柱内镜下手术治疗的38例腰5-骶1腰椎间盘突出症的临床资料,采用经椎间孔入路26例,经椎板间入路12例。手术前后采用疼痛视觉模拟量表（VAS）评分、MacNab量表评分、KPS评分和日本骨科协会（JOA）评分评估疗效。随访时间大于6个月。结果 38例中,34例（89.5%）疗效优良。术后VAS评分[（1.0±1.5）分]较术前[（7.9±1.1）分]明显降低（P<0.05）。术后腰椎JOA评分[（21±5.7）分]较术前[（7.4±4.6）分]明显提高（P<0.05）。经椎间孔入路和经椎板间入路的手术疗效无明显差异。结论 经皮脊柱内镜下选择椎间孔入路或椎板间入路均可有效、安全并且微创地治疗腰5-骶1腰椎间盘突出症。     

腰椎小关节方向性与腰椎间盘突出症

背景：腰椎小关节及其对称性与腰椎间盘突出之间是否存在关系,文献报道争议很大。 目的：测量分析腰椎小关节方向性与腰椎间盘突出的关系。 方法：收集因腰腿痛行CT检查的169例患者,L4/5 腰椎间盘突出35例,L5/S1腰椎间盘突出67例,无间盘突出对照组67例。在CT终端机上选取L3~S1椎间隙的远侧椎体上终板层面,测量3个节段的腰椎小关节角。 结果与结论：① L4/5和L5/S1腰椎间盘突出组L3/4、L4/5、L5/S1每个节段腰椎小关节角左侧均大于右侧(P < 0.05);各组小关节前内侧角和后外侧角两侧相比差异均无显著性意义(P > 0.05)。②各节段腰椎小关节角、前内侧角、后外侧角3组之间比较没有显著性差异(P > 0.05)。③各组腰椎小关节角、后外侧角自L3/4至L5/S1节段均逐渐增大(P < 0.05);而前内侧角L4/5节段最大,L3/4节段最小(P < 0.05)。提示腰椎间盘突出与腰椎小关节角左右侧不相等有关;腰椎小关节角和后外侧角自L3/4至L5/S1逐渐更偏向冠状位,而内侧角在L4/5节段更偏冠状位,可能与腰椎管狭窄的发病有关。     

Percutaneous bipolar radiofrequency thermocoagulation for the treatment of lumbar disc herniation

Lumbar disc herniation is usually managed with conservative treatment or surgery. However, conservative therapy seldom yields good results, and surgery is associated with multiple complications. This study aimed to assess bipolar radiofrequency thermocoagulation for the treatment of lumbar disc herniation. A total of 168 patients with lumbar disc herniation suitable for radiofrequency thermocoagulation were enrolled and randomized to monopolar radiofrequency thermocoagulation (control group, n = 84) or bipolar radiofrequency thermocoagulation (experimental group, n = 84) treatment groups. Ablation sites were targeted under CT scan guidance, and consecutive radiofrequency therapy was used. One and two probes were used for monopolar and bipolar thermocoagulation, respectively. Thermocoagulation was achieved at 50°C, 60°C, and 70°C for 60 s each, 80°C for 90 s, and 92°C for 100 s. Symptoms and complications were evaluated using the modified Macnab criteria and Visual Analog Scale at 7, 30, and 180 days postoperatively. At 180 days, a significantly higher efficacy rate was obtained in the experimental group compared with control patients (91.6% versus 79.7%, P < 0.05). No severe complications were occurred in either group. Targeted ablation via bipolar radiofrequency thermocoagulation is efficient for lumbar disc herniation treatment, and should be further explored for broad clinical application.     

椎板间入路经皮完全内镜手术治疗腰椎间盘突出症

目的评价经椎板间入路的完全内镜手术治疗腰椎间盘突出症的临床效果。方法回顾性分析60例应用经椎板间入路完全内镜手术治疗腰椎间盘突出症的病例资料。病人术前均符合单节段腰椎间盘突出症诊断。记录术前、术后3d、3个月和6个月腿痛VAS和腰椎JOA评分,手术时间、术中及术后并发症。结果60例病人均顺利完成手术,术中出血量少,无任何并发症。平均手术时间65min;平均住院时间4d,切口均一期愈合。术后随访：1例k;病人手术后2个月复发,其他59例病人腿痛VAS和腰椎JOA评分术后3d、3个月、6个月各个随访时间点与术前比较,均有显著性差异（P〈0.01）,术后3个月与6个月间比较无显著性差异（P〉0.05）。结论椎板间入路完全内镜手术治疗下腰椎椎间盘突出症具有微创、术后恢复快等特点,可获得良好临床疗效。     

经皮微通道显微手术治疗腰椎间盘突出症的效果分析

目的 探讨经皮微通道显微手术治疗单节段腰椎间盘突出症的效果.方法 回顾性分析2018年12月至2020年2月经皮微通道显微手术治疗的16例单节段腰椎间盘突出症的临床资料.结果 16例均顺利完成手术,手术时间平均(105.00±18.07)min,术中失血量平均(43.75±11.03)ml,术后无感染、神经根损伤、硬脊...     

经皮内镜椎间孔入路腰椎间盘切除术并发硬脊膜撕裂的综合处理及疗效分析

目的 探讨经皮内镜椎间孔入路腰椎间盘切除术（PETD）治疗腰椎间盘突出症并发硬脊膜撕裂的处理方法及预后。方法 回顾性分析2016年3月至2017年1月采用PETD治疗的236例腰椎间盘突出症的病例资料。结果 236例中,3例发生硬脊膜撕裂,发生率为1.3%(3/236)。2例术中诊断,其中1例术中转为显微镜下修补硬脊膜,1例术中未做处理;1例术后诊断,在显微镜下完成硬脊膜修补。3例随访12个月,末次随访时视觉模拟量表评分从术前8.0分降至1.7分,Oswestry功能障碍指数从82.1%降至17.8%,均无神经功能障碍等后遗症;改良MacNab评分2例为优,1例为良。结论 硬脊膜撕裂是PETD较为少见的并发症,应根据术中和术后情况,采取综合治疗措施,总体预后良好