巨大腰椎间盘脱出游离至上位椎体中上部1例报道

正腰椎间盘变性、纤维环破裂、髓核突出刺激或压迫神经根、马尾神经所产生的一系列综合病症被称为腰椎间盘突出症。其根据髓核突出的不同程度分为四型:a)膨出型。纤维环及后纵韧带完整,髓核组织弥漫性膨出;b)突出型。髓核从破裂的纤维环处突出,后纵韧带仍完整;c)脱出型。纤维环、后纵韧带均破裂,髓核从破口处突出,但其根部仍在椎间隙内;d)游离型。髓核组织完全突入椎管内。由于重力及局部解剖因素,临床上常见的椎间盘脱出髓核移位主要向后下     

破裂型腰椎间盘突出症134例报告

腰椎间盘突出症是引起腰腿痛的常见病因之一。大部分腰椎间盘突出症经传统的保守治疗可取得一定疗效。因腰椎间盘纤维环破裂,髓核脱出,在临床上并非少见,且非手术治疗难以凑效,我院在1989年6月至1996年3月共手术治疗腰椎间盘突出症853例,经手术证实为椎间盘纤维环破裂,髓核脱出或游离于椎管内共134例,占15％,现将诊治情况报告如下。     

长短杠杆推拿手法联合功能训练治疗腰椎间盘突出症45例临床观察

<正>腰椎间盘突出症是临床骨科常见病,椎间盘劳损变性、纤维环破坏或髓核脱出压迫或刺激脊神经、脊髓等引起的一系列症状即为腰椎间盘突出症。30-60岁人群是腰椎间盘突出症的主要发病人群,患者临床会表现出腰腿酸痛、下肢放射痛、肢体麻木等症状,严重影响腰腿正常功能~([1-2])。西医通常给予腰椎间盘突出症患者抗炎药、糖皮质激素等药物以缓解临床症状,但诸多药物禁     

临床症状与髓核突出左右不一致的腰椎间盘突出症的诊治

目的探讨腰椎间盘突出症导致非对称性下肢放射痛的可能原因及术式的选择。方法25例经SCT、MRI检查证实为突出侧与临床症状侧别左右不一致的腰椎间盘突出症患者,均行手术治疗,其中14例行双侧开窗减压探查髓核摘除术,11例仅行突出侧开窗术。结果影像学上髓核突出侧别与术中所见相吻合,但该侧神经根未见到明显压迫或炎性水肿等病理表现;而症状侧无髓核突出,5例神经根未发现异常表现,9例存在不同程度的炎性水肿,其中6例探查发现神经根与对侧髓核不同程度粘连。术后所有患者症状均得到缓解,经过1～5年（平均2．4年）的随访,均无复发。结论SCT结合MRI检查有助于此类腰椎间盘突出症的明确诊断。纤维环无破裂的突出型腰椎间盘突出症,单纯突出侧减压可以获得较好的治疗效果;纤维环破裂的游离型及脱出型腰椎间盘突出症,宜同时行对侧开窗探查。     

破裂腰椎间盘突出症的诊断进展

目前国内外对腰椎间盘突出症的各种手术和非手术方法甚多,意见也不一致,但是多数学者认为破裂型腰椎间盘突出症宜早期手术治疗,反复非手术治疗可延误诊治,甚至出现严重并发症。因此,能正确诊断破裂型腰椎间盘突出症对指导治疗有重要意义,本文就近年来对该病的诊断作一综述。 一、临床表现　腰椎间盘突出症临床表现复杂,一般仅根据病史和体征往往难以对破裂型腰椎间盘突出症确诊［１］,破裂型腰椎间盘突出症,系指腰椎间盘纤维环完全破裂或破碎,并同髓核甚至软骨板脱出于纤维环外,但未完全游离椎管内［２］,可分为脱出后纵韧带下…     

腰椎间盘突出症手术疗效与突出类型及纤维环完整性的关系

目的探讨腰椎间盘突出症手术疗效与突出类型及纤维环完整性的关系。方法回顾性分析经后路椎板开窗髓核摘除术治疗的260例腰椎间盘突出症患者的疗效。病例选择条件:均为下腰椎单节段突出,侧突型(单侧坐骨神经症状),不伴有椎管狭窄。随访6～14年,平均8.5年。根据术中所见椎间盘突出的髓核形态及纤维环破损大小,将椎间盘突出症分为四种类型,并对不同类型的术后疗效进行统计学分析比较。结果椎间盘髓核突出较大、纤维环破损较小者,术后疗效佳,复发率低;反之,髓核突出较小或纤维环破损大者,术后疗效差,复发率高。结论腰椎间盘突出症的手术效果与椎间盘突出类型及纤维环的完整性有密切的联系。对临床症状较轻、间盘突出较小且突出物基底较宽的患者应尽量避免开放式手术。椎间盘突出摘除术中除应注意保持脊柱骨性结构的稳定性,还应尽量避免过多地破坏椎间盘纤维环的完整性。     

推拿致腰椎间盘急性破裂脱出(附9 例报告)

腰椎间盘突出症较为常见，如治疗不当可给患带来长期痛苦。本报告我们收治腰椎间盘突出症228例，其中9例因推拿加旋复位致患腰腿痛症状较治疗前明显加重，经作CT或MRI示：腰椎间盘纤维环急性破裂，髓核脱出。现将诊断治疗情况报告如下。     

游离型腰椎间盘突出症诊治分析

腰椎间盘突出症按其病理［１］可分为：隆起型、破裂型、游离型,游离型是指纤维环完全破裂,髓核碎块经纤维环破裂口脱出,游离于椎管内。游离髓核不仅直接压迫神经根或硬膜囊,而且产生化学性刺激［２］,使患者表现发病急、症状重,同时又因其游离髓核碎块有时可远离病...     

难治性腰椎间盘突出症的处理

临床上髓核突入椎管内的腰椎间盘突出症多采用靶点射频加O3-O2注射,或胶原酶溶盘治疗;但对突出物过大、突出髓核变性硬化以及髓核脱出或脱垂等特殊情况,上述微创技术难以凑效,如病人坚持不接受手术,确属难治性腰椎间盘突出症.     

移位型腰椎间盘突出的诊治与分型商榷

在１９８８年３月～１９９５年１２月期间,我们共手术治疗腰椎间盘突出症４４２例,其中有１８例纤维环破裂后,脱出的髓核并不位于同一间隙破裂纤维环的旁边,而是下降了１／２或１／３个椎体高度,我们将这种脱出的椎间盘称为“移位型腰椎间盘”,列为我们分出的５种腰...     

Cervical intervertebral disc space narrowing and size of intervertebral foramina

Computer-assisted simulation of C4-C5, C5-C6, and C6-C7 intervertebral disc space narrowing was performed on 16 anatomic specimen cervical spines to determine the relationship of the cross sectional foraminal areas with the degree of narrowing of the cervical intervertebral disc space. Compared with normal foraminal area values, reduction of 20% to 30% of the foraminal area was found after 1 mm narrowing of the intervertebral disc spaces; reduction of 30% to 40% of the foraminal area was found after 2 mm narrowing of the intervertebral disc space; and reduction of 35% to 45% of the foraminal area was found after 3 mm narrowing of the intervertebral disc space. Statistically significant differences were found among the remaining cross sectional foraminal areas after different degrees of intervertebral disc space narrowing. Compression of the nerve root within the intervertebral foramina after the collapse of the intervertebral disc space cannot be ignored, and an appropriate surgical procedure to maintain the normal height of the disc space is essential. The size of the intervertebral foramen is related directly to the height of the intervertebral disc space. A 3-mm vertical reduction of the intervertebral disc space is associated more frequently with severe narrowing of the neuroforamen.     

经单侧椎间孔腰椎椎体间融合术的临床应用

腰椎融合术是治疗下腰椎疾患的一种有效方法。由于既要考虑减少后柱结构的破坏和硬膜外疤痕形成,又要保证植骨床良好的准备和前柱支撑。骨科医生在手术过程中常常顾此失彼。近年来,LoweandTaharnia[1] 报道经单侧椎间孔径路显露椎间隙,使用多种椎间隙撑开方法显露术野,植入钛网融合器来完成椎体间融合(unilateraltransforaminallumbarinterbodyfusion ,简称TLIF技术)。我院自2 0 0 2年底开展此技术,治疗3例下腰椎疾患。报告如下。1　临床资料本组男1例,女2例。年龄39～5 5岁,平均4 6 .4岁。病变间隙均为L4 ,5节段,2例为腰椎间盘突出并侧…     

Postoperative intervertebral discitis

Discitis is a rare complication of disc operation. During a 10-year-period 1100 patients were operated for lumbar disc herniation and only eight patients developed postoperative discitis. The symptoms began 3 weeks after the operation and the most prominent clinical feature was back pain with muscle spasm. The sedimentation rate was highly elevated but the body temperature was slightly elevated for only a few days. Typical radio-graphic findings were narrowing of the affected disc space and end-plate resorption 3-4 weeks after the initial symptoms. In the early phase, CT showed hypodense disc material in the affected disc space, which may be the first radiological sign of discitis.     

Postoperative intervertebral discitis

Discitis is a rare complication of disc operation. During a 10-year-period 1100 patients were operated for lumbar disc herniation and only eight patients developed postoperative discitis. The symptoms began 3 weeks after the operation and the most prominent clinical feature was back pain with muscle spasm. The sedimentation rate was highly elevated but the body temperature was slightly elevated for only a few days. Typical radiographic findings were narrowing of the affected disc space and end-plate resorption 3-4 weeks after the initial symptoms. In the early phase, CT showed hypodense disc material in the affected disc space, which may be the first radiological sign of discitis.     

经皮内窥镜下射频消融术治疗腰椎间盘突出症

目的:探讨经皮内窥镜下射频消融术治疗腰椎间盘突出症的安全性和疗效。方法:58例确诊为单纯性腰椎间盘突出症患者(其中L4/5突出44例,L5/S1突出13例,L3/4突出1例),在C型臂X光机透视监视下,采用经皮穿刺技术将同轴椎间盘内窥镜置入椎间盘内,摘除部分髓核后,在直视下采用ELLMAN射频机的双极可弯曲电极行髓核组织消融,完全去除镜下所见髓核组织。结果:采用MacNab标准评定,58例患者随访1~8个月,显效36例(62%),有效16例(28%),无效6例(10%),有效率为90%。所有病例均无严重并发症发生。结论:经皮内窥镜下射频消融术治疗单纯性腰椎间盘突出症安全、有效。     

腰椎间盘突出与有无临床症状的影像对照研究

目的：探讨应用区域定位评分法研究腰椎间盘突出（膨出、突出、脱出）有临床症状与无临床症状的相关性及原因分析。方法：将符合要求的CT病理分型为膨出、突出、脱出的体检或住院或门诊患者120例,按有临床症状与无临床症状分为2组,每组按CT病理分型分3组,年龄20-59岁,平均38．5岁,有临床症状与无临床症状两组间在性别、年龄、病程及椎间盘分布节段差异均无统计学意义;应用区域定位评分法对各组评分;用游标卡尺分别测量矢状径指数（SI）、盘黄韧带前间隙、侧隐窝上口宽度、硬膜囊前后径。CT值由X线断层扫描测定,分别测量3次,取平均值。结果：④腰椎间盘突出有临床症状与无临床症状两组在SI、CT值、CT评分、硬膜囊前后径之间差异无统计学意义（P〉0．05）;在侧隐窝上口宽度、盘黄韧带前间隙之间差异有统计学意义（P〈0．05）。②腰椎间盘突出有临床症状与无临床症状两组突出类型比较,差异有统计学意义（P〈0．05）;腰椎间盘脱出有临床症状与无临床症状两组突出节段比较,差异有统计学意义（P〈0．05）。结论：①腰椎间盘突出大小、部位、类型不一定与临床症状存在必然关系,腰椎间盘突出症与压迫程度无正比关系;②椎管内突出髓核是否导致相应的临床症状存在着诸多或必然因素,可能与椎间盘突出物可代偿的椎管储备容量、受累神经根对机械压迫的逃逸避让与弹性延长功能,以及受累神经根低氧消耗与抗缺血性损伤代偿作用等因素有关。     

Biomechanics of intervertebral disk degeneration

Degenerative changes in the material properties of nucleus pulposus and anulus fibrosus promote changes in viscoelastic properties of the whole disc. Volume, pressure and hydration loss in the nucleus pulposus, disk height decreases and fissures in the anulus fibrosus, are some of the signs of the degenerative cascade that advances with age and affect, among others, spinal function and its stability. Much remains to be learned about how these changes affect the function of the motion segment and relate to symptoms such as low back pain and altered spinal biomechanics.