小切口多段分段开窗治疗多间隙腰椎间盘突出症

目的 评价小切口多段多段开窗髓核摘除治疗多间隙腰椎间盘突出症的疗效;方法 联合应用小切口多段分段椎板开窗髓 或开窗髓核摘除加椎板开窗局限减压等多种术式治疗多间隙腰椎间盘突出83例,术中不损伤棘上、棘间韧带,不切除小关节。结果:76例获随访,时间6个月－36个月平均1．5年,优良率93．9％。结论 小切口多节段开窗髓核摘除或开窗减压治疗多间隙腰椎间盘突出症;对脊柱结构上。创伤小、时间短,即最大限度地减少了并发症的发生又达到了治疗目的。     

手术治疗高位腰椎间盘突出症60例

目的探讨高位腰椎间盘突出症的临床特点、诊断及治疗方法。方法60例高位腰椎间盘突出症患者中,15例行全椎板减压髓核摘除内固定,8例行半椎板减压髓核摘除,7例行双侧开窗髓核摘除,3例行经峡部外缘入路髓核摘除,27例行单侧开窗髓核摘除（其中神经根管扩大6例）。结果60例均获随访,时间6～36个月。术中硬脊膜破裂脑脊液漏3例,无神经损伤病例出现。参考陆裕朴疗效评定标准：优50例,良8例,可2例,优良率96.7%。结论高位腰椎间盘突出症的临床表现复杂,应根据临床查体结合影像学检查选择手术入路。对于年轻、单节段及旁侧型的椎间盘突出症者选择单侧开窗或半椎板减压髓核摘除;对多间隙、中央型突出髓核大者选择双侧开窗或全椎板减压髓核摘除加内固定。     

小切口椎板间开窗术治疗腰椎间盘突出症(附200例体会)

对200例诊断为无骨性椎管狭窄的腰椎间盘突出症患，采用小切口椎板间“开窗”或扩大“开窗”术除突出之椎间盘髓核。随访1-5年，患临床症状缓解，优良率达97％。小切口椎板间开窗术治疗椎间盘突出症创伤轻，手术效果良好，术后并发症少，基层医院较为实用。     

节段开窗髓核摘除对腰椎稳定性的影响

目的 本研究观察了腰椎椎板节段开窗髓核摘除对腰椎稳定性的影响。方法 ７具新鲜腰骶椎标本头尾端固定,模拟人体行屈曲,侧弯和旋转活动,随后顺序进行Ｌ３－Ｓ１椎板节段开窗及Ｌ４－５,Ｌ５,Ｓ１髓核摘除,对比观察术前和多节段椎板双侧开窗及髓核摘除术后腰椎各节段在三维空间的位移变化,结果 单纯多节段开窗后屈江活动时Ｌ４,５前后水平和轴向位移分别增加１８％和１６％,Ｌ５Ｓ１则分别增加１９％和４５％,椎板开窗加     

椎板开窗减压髓核摘除术治疗腰椎间盘突出症

目的：探讨应用腰椎后路椎板开窗减压髓核摘除术治疗腰椎间盘突出症的方法及疗效。方法：回顾以往应用该方法治疗的32例腰椎间盘突出症病例。术中咬除椎间盘髓核突出部位相应的上椎板部分下缘及下椎板上缘,呈开窗状,切除增厚的黄韧带、增生的椎体后缘和关节突内侧皮质骨、钙化的后纵韧带及突出的纤维环和髓核,术后观察其疗效。结果：术后全部随访6—36个月,优良率达92％。结论：腰椎后路椎板开窗减压髓核摘除术治疗椎间盘突出症具有创伤小,对腰椎功能影响小,疗效好。     

腰椎手术失败综合征的原因分析及再手术治疗

目的探讨腰椎手术失败综合征的主要原因及再手术治疗效果。方法下腰椎术后综合征患者24例，单侧椎板开窗髓核切除10例，全椎板切除髓核切除14例，其中椎弓根内固定3例，均再次手术。再手术术式包括：半椎板或全椎板减压，髓核切除，椎管神经根管彻底减压，椎弓根内固定，椎间融合或后外侧植骨融合。结果腰椎手术失败综合征原因为同一节段椎间盘突出复发或相邻节段椎间盘退变突出，原手术节段或相邻节段椎管狭窄，手术定位错误，内固定失败。24例获2个月～3年随访，再手术后均获得满意效果。临床改善率为80．2％。优18例，良6例。结论下腰椎手术失败后，积极、合理地再手术治疗，仍能获得满意疗效。     

椎弓根钉棒加关节突植骨治疗腰椎失稳并椎间盘突出症

目的：观察椎弓根钉内固定、一侧开窗髓核摘除、对侧小关节、椎扳间植骨融合治疗单纯下腰椎失稳（I度以内滑脱）合并一侧椎间盘突出症的手术效果。方法：采用后路减压椎弓根系统内固定、一侧开窗髓核摘除、对侧小关节椎扳间植骨融合治疗23例。并对术后植骨融合手术效果进行评价。结果：优19例,良4例。术后随访1-3年,脊柱无失稳,椎弓根螺钉无松动,临床症状基本消失,植骨融合率为：第一年82％,第二年全部骨性融合,椎间隙高度无丢失。结论：采用椎管减压,髓核摘除椎弓根内固定及小关节、椎板间植骨融合,可达到脊柱稳定、解除症状的目的。     

腰椎间盘突出合并椎管狭窄的手术治疗

目的研究半椎板开窗，髓核摘除，椎管潜行扩大的手术方法及治疗效果。方法对于侧旁型，中央型分别采用单开、双开窗，髓核摘除，合并椎管狭窄者则行椎管潜行扩大。结果手术病人86例并经随访5年，其中优41例，良36例，差9例。结论采用半椎板开窗，髓核摘除，同时对于合并椎管狭窄者行椎管潜行扩大。即准确取出髓核，解除神经根压迫，减轻椎管狭窄，是一种有效的手术方法。     

关于腰椎间盘突出症手术策划的商榷

目的：对腰椎间盘突出症的众多术式，根据物理体征和影像学的不同表现，探讨相对应的有效术式。方法：通过影像与体征的不符，退行性多节段椎管狭窄，提出椎管减压的关键操作和手术技巧，MED后正中入路选择的多种术式。结果：探查部位以症状侧首选，影像侧常规接着减压；退行性多节段开窗；老年人中央型腰椎间盘突出以椎板次全切除为主；侧椎管狭窄者以半椎板切除为主；年轻人无论什么类型的椎间盘突出症均以开窗为主。结论：任何术式的成功均取决于椎管减压的彻底，髓核摘除的干净，神经根的充分游离，腰椎稳定的保持。     

多节段腰椎管狭窄症的手术治疗和评价

目的：探讨多节段腰椎管狭窄症的诊断和治疗。方法：收集４８例临床表现为间歇性跛行病人,分别进行脊髓造影和ＣＴ检查。手术疗法分全椎板切除、半椎板切除及双侧椎板间开窗等三种术式组。结果：４８例均为两个节段以上椎管狭窄、手术证实脊髓造影和ＣＴ诊断符合率分别为９６％和９２％。三组术式疗效差异无显著性（Ｐ〉０．０５）。结论（１）两个节段以上的腰椎管狭窄症表现有神经性间歇性跛行的临床特征。（２）手术治疗的关键是     

Stability of the whole lumbar spine after multilevel fenestration and discectomy.

STUDY DESIGN: An investigation of the in vitro biomechanical effects of multilevel fenestrations and discectomies on the behavior of whole lumbar spine motion, using a material testing system (Instron 1341, Instron Limited, High Wycombe, England) and Elite three-dimensional motion analysis system (BTS, Milano, Italy). OBJECTIVES: To investigate the effects of multilevel fenestrations and discectomies on the stability of the whole lumbar spine, including segmental stiffness and sagittal (horizontal and vertical) translation. SUMMARY OF BACKGROUND DATA: In the management of lumbar spinal stenosis, wide decompressive laminectomy with partial or total facetectomy has been the standard procedure for multilevel nerve decompression. Main complications with these procedures have been instability and chronic pain syndrome. Multilevel fenestration with undermining enlargement of the spinal canal has been selected for multilevel nerve decompression in recent years. However, the biomechanical effects of multilevel fenestration and discectomy have been controversial and difficult to validate. This study investigated the in vitro biomechanical effects of multilevel fenestrations and discectomies on motion behavior of the whole lumbar spine. METHODS: Seven fresh human specimens from L1 to sacrum were used in this study. The fenestrations and discectomies consisted of L3-L4 bilateral fenestration, L4-L5 bilateral fenestration, L5-S1 bilateral fenestration, L4-L5 discectomy, and L5-S1 discectomy. Flexion, lateral bending, and axial rotation (torsion) loading were applied. Ranges of motion were determined two-dimensionally by the Elite system with an infrared camera. The postoperation results were compared with the intact conditions. RESULTS: After multiple fenestrations, the sagittal ranges of motion at L4-L5 increased by 18% anteroposteriorly and 16% vertically under the flexion loads. At L5-S1, the motions increased by 19% and 45%, respectively. After fenestrations and discectomies, the ranges of motion in the sagittal plane increased by 28% horizontally and 71% vertically at L4-L5, and 14% and 166% at L5-S1. Motion increases were statistically significant (P < 0.05) in vertical translations. However, after the multilevel surgeries, no significant motions were found in each of the lumbar segments during lateral bending and axial rotation. CONCLUSIONS: The results demonstrate that multilevel fenestrations and discectomies affect lumbar spinal stability in flexion, but have no effect on the stability of the lumbar spine in lateral bending or axial rotation.     

Increased fusion rates with cervical plating for three-level anterior cervical discectomy and fusion

STUDY DESIGN: A retrospective review of all patients surgically treated by a single surgeon with a three-level anterior cervical discectomy and fusion with and without anterior plate fixation. OBJECTIVES: To compare the clinical and radiographic success of anterior three-level discectomy and fusion performed with and without anterior cervical plate fixation. SUMMARY OF BACKGROUND DATA: Previous studies of multilevel cervical discectomies and fusions have shown fusion rates to decrease as the number of surgical levels increases. Anterior cervical plate stabilization can provide more stability and may increase fusion rates for multilevel fusions. METHODS: Over a 7-year period, 59 patients were treated surgically with a three-level anterior cervical discectomy and fusion by the senior author. Forty patients had cervical plates, whereas 19 had fusions with no plates. These patients were observed for an average of 3.2 years. Clinical and radiographic follow-up data were obtained. RESULTS: Of the 59 patients, 14 had a pseudarthrosis (7 in each group). The pseudarthrosis rates were 18% (7 of 40) for patients with plating and 37% (7 of 19) for patients with no plating. Although the nonunion rate for unplated fusions was double that of plated fusions, this difference was not statistically significant. There was no statistically significant correlation between pseudarthrosis and gender, age, level of surgery, history of tobacco use, or previous anterior surgery. The fusion rates were improved with the use of a cervical plate. Inferior clinical results were demonstrated in patients with a pseudarthrosis, regardless of the use of a cervical plate. CONCLUSIONS: The addition of plate fixation for three-level anterior cervical discectomy and fusion is a safe procedure and does not result in higher complication rates. In this study, the pseudarthrosis rate was lower for patients with a cervical plate. However, this difference was not statistically significant. Patients treated with cervical plating had overall better results when compared with those of patients treated without cervical plates. Although the use of cervical plates decreased the pseudarthrosis rate, a three-level procedure is still associated with a high nonunion rate, and other strategies to increase fusion rates should be explored.     

严重多囊肝的外科处理

目的　严重多囊肝外科处理上较困难 ,治疗后症状再发率较高 ,本文探讨目的为提高对严重多囊肝的处理水平。方法　对 2 2例获随访的严重多囊肝病例按治疗方法不同 ,对疗效进行分析 ,讨论了治疗方法的选择与疗效的关系。结果　肝部分切除加开窗术、剖腹肝囊肿开窗术、B超下穿刺治疗及腹腔镜肝囊肿开窗术在术后 0 5～ 7年 (平均 3年 )内症状再发 ,再发率分别为 0 ,2 8.5 % ,6 5 .5 %及 10 0 %。结论　肝部分切除加开窗术是治疗严重肝囊肿的有效方法 ;B超下穿刺治疗更适合作为手术前后暂时缓解症状的辅助手段 ;腹腔镜开窗术应慎用于严重多囊肝病人     

不同术式治疗复发腰椎间盘突出症的对比研究

目的 评价单节段腰椎间盘突出症术后复发再次手术的远期疗效,并比较采用不同术式的远期结果.方法 1998年2月-2003年2月,共行95例复发腰椎间盘突出症再手术,其中89例(93.7%)获随访并复习原始资料,76例符合研究纳入标准.男55例,女21例;年龄23～61岁,平均42岁.患者均有再次坐骨神经疼痛病史.复发时间8～130个月,平均69个月.位于L4、5节段48例,L5、S1间隙28例.再次手术分为3组,A组30例,单纯扩大开窗或双侧开窗髓核摘除术;B组24例,全椎板切除髓核摘除术;C组22例,全椎板切除髓核摘除360°融合内固定术.比较3组患者的临床治疗基本情况,采用临床功能评估标准进行临床疗效评估.结果 A、B、C组术中出血量分别为(110.7±98.8)、(278.7±256.3)和(350.74±206.1)mL,手术时间分别为(65.94±22.8)、(111.64±24.3)和(127.34±26.7)min,术后住院时间分别为(6.74±1.4)、(10.24±1.8)和(12.24±2.3)d,B、C组与A组比较差异均有统计学意义(P＜0.05),B、C组间比较差异无统计学意义(P＞0.05).术后获随访36～96个月,平均86个月;A组(87.6±27.0)个月,B组(84.5±19.8)个月,C组(83.6±13.5)个月.3组的年龄、随访时间比较差异均无统计学意义(P＞0.05).3组总临床结果 优良率80.3%,其中A组80.0%,B组79.2%C组81.8%,3组比较差异无统计学意义(P＞0.05).随访结束时摄X线片示手术节段椎体不稳发生率,A组1例(3.3%),B组19例(79.2%),C组无.B组发生率高于A、C组,差异有统计学意义(P＜0.05).结论 复发腰椎间盘突出症再次手术是必要的,单纯扩大开窗或双侧开窗髓核摘除术是较理想的方法.     

Treatment of multilevel cervical fusion with cages

BACKGROUND: Multilevel cervical discectomy usually requires plate and screw fixation for maintaining the spinal curvature, and increasing the graft fusion rate. However, the use of plate and screw fixation may cause a few complications, such as screw breakage, screw pullout, esophagus perforation, and cord or nerve root injury. In this study, we try to use cages to replace plate function in multilevel cervical fusion. METHODS: From January 1997 to June 2001, there were 180 consecutive cases of multilevel cervical degenerative disease. We randomized them into three groups: Group A (60 patients) underwent anterior discectomy and polyetheretherketone (PEEK) fusion, Group B (50 patients) underwent anterior discectomy, autogenous iliac crest graft (AICG) fusion and plate fixation, and Group C (70 patients) underwent anterior discectomy and AICG only. X-ray of cervical spine was taken every 3 months until fusion was complete. Spinal curvature was measured by lateral view of X-ray. The functional and working status were evaluated by Prolo scale. Blood loss and operation time were recorded, respectively. RESULTS: The total complication rates were 3.3%, 16%, and 54.3% in Groups A, B, and C respectively. The graft complications were evaluated by radiographic findings (graft collapse, nonunion, or dislodged graft). However, only 37.1% of patients (13/35) with graft complications had clinical symptoms (severe neck pain, radicular pain, or neurologic deficits). The fusion rate was better, and the time to fusion was sooner in Groups A and B than Group C, p < 0.001 (chi(2) test). PEEK cage is statistically better than plating group in total complications, p < 0.05. Graft collapse and nonunion were the major graft complications in Group C (AICG without plating). Screw pullout, and screw breakage were the main causes of plating complication. Blood loss was minimum in Group A, p < 0.05. Spinal lordosis increased by a mean of 4.61 +/- 2.93 mm and 1.68 +/- 5.02 mm in Groups A and B, respectively, but spinal kyphosis increased by a mean of -2.09 +/- 4.77 mm in Group C. Group A had a statistically better Prolo scale than Group C, p < 0.0001. CONCLUSIONS: Both PEEK cage without plating and AICG with plating are good methods for interbody fusion in multilevel cervical degenerative diseases. They increase spinal lordosis and graft fusion rate, and cause fewer surgical complications. However, PEEK cage is preferred in our study for multilevel fusion, because it has the fewest complication rates and the least amount of blood loss.     

Anterior cervical discectomy without interbody fusion

BACKGROUND: The use of an interbody bone graft during anterior cervical discectomy remains a controversial topic. This study presents the outcome of 64 consecutive patients who underwent anterior cervical discectomy without an interbody fusion. METHODS: Sixty-four consecutive patients underwent anterior cervical discectomy without interbody fusion by one surgeon at Indiana University School of Medicine between April 1994 and February 1998. A retrospective analysis of these cases was performed to evaluate outcome of this procedure. Outcome was determined using the criteria of Odom and Finney. RESULTS: In our series of patients, the mean age was 49.4 years, and the mean time of follow-up was 8.5 months. The presentation was as follows: 69% radiculopathy alone, 23% combined myelopathy and radiculopathy, and 8% myelopathy. Although 31% of the patients had symptoms for more than 1 year, the mean duration of symptoms of the remainder of patients was 3.2 months. The majority of patients had single-level disease (77%); however, 25% underwent 2 level discectomies, and 2% underwent 3 level discectomies. Twenty-four patients (38%) had soft disc herniation, and 40 patients (62%) had hard disc herniation. Of the 64 patients, 91% had either good or excellent outcomes, 9% had satisfactory outcomes, and none had a poor result. Ninety-six percent of the patients with soft disc herniation had good or excellent outcomes, whereas 88% of the patients with hard disc had good or excellent outcomes (p = 0.217). Ninety-one percent of the patients who worked before surgery returned to work after their operation. None of the patients required reoperation at the operative level or exhibited instability at the operative level. Postoperative complications included transient intrascapular pain (13%), kyphotic deformity (3%), transient vocal cord paralysis (2%), and temporary dysphagia (2%). No significant difference in age or outcome existed when comparing males to females. CONCLUSION: Satisfactory results can be attained by discectomy without an interbody fusion in the surgical management of cervical disc disease.     

经皮内窥镜下腰椎椎间盘切除术与椎板开窗椎间盘切除术治疗青少年腰椎椎间盘突出症

目的　比较经皮内窥镜下腰椎椎间盘切除术(PELD)与椎板开窗椎间盘切除术治疗青少年腰椎椎间盘突出症(LDH)的临床疗效。方法 2012年1月—2016年12月,海军军医大学附属长征医院收治青少年LDH患者82例,其中40例(A组)采用PELD治疗,42例(B组)采用椎板开窗椎间盘切除术治疗。记录并比较2组患者手术时间、术中出血量、术后卧床时间、咬骨体积,以及术前、术后1个月和末次随访时疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)。结果所有手术顺利完成,所有患者随访12个月。A组手术时间、术中出血量、术后卧床时间及咬骨体积均低于B组,差异有统计学意义(P 0.05)。2组患者术后VAS评分和ODI均较术前明显改善,差异有统计学意义(P 0.05);组间比较术后VAS评分和ODI,差异均无统计学意义(P 0.05)。末次随访时MacNab疗效评定优良率A组为92.50%(37/40),B组为90.48%(38/42),差异无统计学意义(P 0.05)。A组并发症发生率为5.0%(2/40),B组为7.1%(3/42),差异无统计学差异(P 0.05)。结论 PELD可取得与传统椎板开窗椎间盘切除术相近的临床疗效,且可降低出血量,减少骨性结构破坏,缩短患者术后卧床及康复时间,是较为理想的治疗青少年LDH的微创方法。     

Anterior corpectomy with iliac bone fusion or discectomy with interbody titanium cage fusion for multilevel cervical degenerated disc disease

STUDY DESIGN: Clinical and radiologic study evaluating the outcome after anterior corpectomy with iliac bone fusion compared with discectomy with interbody titanium cage fusion for multilevel cervical degenerated disc disease. OBJECTIVES: To investigate the safety and effectiveness of interbody titanium cage with plate fixation in multilevel postdiscectomy fusion. SUMMARY OF BACKGROUND DATA: The operation for segmental multilevel cervical degenerated disc disease remains controversial. Data on safety and efficacy of titanium cages in multilevel postdiscectomy fusion are rarely available. We investigated the safety and effectiveness of interbody fusion cages with plate fixation and compared the clinical and radiographical results between anterior corpectomy and iliac bone fusion with plate fixation and multilevel discectomy and cage fusion with plate fixation. METHODS: Sixty-two patients were treated with either a multilevel discectomy and cage fusion with plate fixation (27 patients, group A) or an anterior corpectomy and iliac graft fusion with plate fixation (35 patients, group B). We evaluated the patients for cervical lordosis, fusion status, and stability 24 months postoperatively on the basis of spine radiographs. The patients' neurologic outcomes were assessed by the Japanese Orthopedic Association (JOA) scores. Neck pain was graded using a 10-point visual analog scale. RESULTS: Both groups A and B demonstrated a significant increase in the JOA scores (preoperatively 11.1+/-2.1 and 10.4+/-3.5, postoperatively 14.3+/-2.4 and 13.9+/-2.1, respectively) and a significant decrease in the visual analog pain scores (preoperatively 8.5+/-1.1 and 8.7+/-1.5, postoperatively 2.9+/-1.8 and 3.0+/-2.0, respectively). However, there was no significant difference between groups A and B. Both groups A and B showed a significant increase in the cervical lordosis after operation and reached satisfactory fusion rates (96.3% and 91.4%, respectively). Three patients (two 2-level corpectomies and one 3-level corpectomy) had construct failures that required a second operation. Eight of 35 patients who underwent iliac bone fusion had donor site pain. The hospital stay in group A was significantly shorter than that in group B (P=0.022). CONCLUSIONS: Either a multilevel discectomy and cage fusion with plating or a corpectomy and iliac bone fusion with plating provides good clinical results and similar fusion rates for cervical degenerative disc disease. However, absence of donor site complications and construct failures and shorter hospital stay make the multilevel discectomy and cage fusion with plate fixation better than corpectomy and strut graft fusion with plate fixation.     

A comparison of fusion rates between single-level cervical corpectomy and two-level discectomy and fusion

A single corpectomy and strut grafting has been proposed as an alternative to performing two-level adjacent discectomies with multiple grafts to produce superior fusion rates. The purpose of this study was to compare the clinical and radiographic success of two-level discectomy and fusion with anterior cervical plate fixation compared with a single-level corpectomy. Fifty-two patients were treated with either a two-level adjacent anterior cervical discectomy and fusion with cervical plating, or by a single-level corpectomy and plate. Thirty-two patients had two-level discectomies, whereas 20 had a single corpectomy and a strut graft (average follow-up was 3.6 years). One patient had a pseudarthrosis from a single-level corpectomy and required subsequent surgery to obtain an osseous union. The fusion rates between the two groups was not statistically significant (p = 0.385). The clinical results of the surgeries were similar between the groups based on Odom's criteria. The addition of cervical plates to either two-level discectomies or single-level corpectomies yielded similar fusion and complication rates.