通用型脊柱内固定系统(GSS)治疗胸腰椎骨折

目的总结应用GSS内固定手术治疗胸腰椎骨折的方法和治疗效果。方法68例胸腰椎骨折患者采用GSS行后路减压植骨内固定术。结果经3~21个月随访,椎体平均高度由术前的前39.5%和后76.4%恢复到术后的前94.2%和后97.3%,Cobb角由术前平均23.8°恢复为术后平均2.9°。神经功能按ASIA标准评价,51例有1~3级恢复。结论GSS治疗胸腰椎骨折具有操作简便、复位效果好、植骨融合率高及固定可靠的优点,在脊柱内固定器械中具有较明显的优越性。     

Moss Miami内固定系统在腰椎退行性不稳症手术中的应用

目的探讨Moss Miami内固定系统在腰椎退行性不稳症手术治疗中的应用价值.方法 从2002年1月到2003年5月间,对28例腰椎退行性不稳症者采取后路减压、后外侧植骨融合、Moss Miami系统内固定治疗,术后定期摄片随访,对其症状缓解、植骨融合、内固定及感染等并发症情况进行观察.结果所有患者获得16～32个月(平均22个月)的随访,根据JOA评分,本组患者改善率为79%～98%,平均为86%;术后6个月融合率为82.1%,9个月融合率为89.3%;无患者死亡,2例出现局部并发症;无螺钉松动及断裂发生.结论椎弓根螺钉内固定、减压加后外侧植骨融合治疗腰椎退行性不稳症具有并发症少、融合率高、疗效好的优点,Moss Miami内固定系统操作简便,切迹低,适用于腰椎退行性不稳症的治疗.     

应用TSRH椎弓根钉系统治疗腰椎不稳症

目的：评价ＴＳＲＨ椎弓根钉系统在治疗腰椎不稳症中效果。方法：对２１例腰椎不稳症患者行ＴＳＲＨ椎根钉系统内固定手术,术后随诊分析。结果：２１例获平均２０．９个月的随访,植骨晤率为９５．２％,疗效满意。结论：ＴＳＲＨ椎弓根钉系统简单、固定牢靠,适用于腰椎不稳症的手术治疗。     

GSS系统内固定联合植骨治疗腰椎滑脱症

目的探讨后路应用通用型脊柱内固定系统(general seine system,GSS)复位固定、减压、椎体间及后外侧植骨融合治疗腰椎滑脱症临床效果。方法对42例腰椎滑脱症行后路椎管减压,应用GSS椎弓根系统对滑脱椎体进行复位固定,椎体间和后外侧植骨融合。结果随访6～48个月,临床优良率88．1％,6～12个月复查X线片均显示椎体间骨性融合。结论GSS椎弓根螺钉系统能有效撑开提拉滑脱椎体,复位满意,固定力强,并为彻底减压提供有效空间。采用椎体间联合后外侧植骨能有效提高植骨融合率。     

应用B-Twin融合器治疗腰椎不稳症的疗效观察

目的应用B-Twin融合器治疗腰椎不稳症,评价其疗效和价值。方法对34例腰椎退变性失稳症患者,采用B-Twin融合器进行后路椎间融合手术,共融合34例36个椎间隙。对所有病例术前、术后复诊时进行JOA评分、X线片椎间隙高度测量,并对融合情况进行考察。结果术后随访时间6～18个月、平均9个月,34例患者术前JOA评分平均(7±1.36)分,术后复诊时平均(22±3.5)分,较术前有显著改善。结果显效26例,有效8例,显效率76.5%。X线片检查显示,平均椎间高度术前(7.5±2.0)mm,术后(11.5±1.3)mm,较术前有显著性差异(P0.05);术后6～12个月椎间高度(11.0±1.5)mm,较术前仍有显著性差异(P0.05),动力位X线片显示腰椎融合率88%,B-Twin下沉率23.5%,未发现B-Twin移位。结论应用B-Twin融合器治疗腰椎退变性不稳症,是一种有效方法,严格把握适应证是确保手术长期疗效的前提,手术技巧、B-Twin的最佳大小、植骨技术和数量是确保其近期手术效果的关键。     

腰椎间盘突出症合并腰椎不稳的手术治疗

腰椎间盘突出症合并腰椎不稳的手术治疗谢硕胜１陈海１自１９９２年至１９９６年手术治疗腰椎间盘突出症１８９例，对其中３６例术前存在腰椎不稳和／或可能在术后出现明显腰椎不稳倾向者，我们在椎间盘切除的同时做椎体间植骨融合术，收到了较好效果。１临床资料１．１一...     

应用可撑开融合器B-twin治疗腰椎不稳症的疗效观察

【摘要】 目的：探讨应用可撑开融合器B-twin治疗腰椎不稳症的临床疗效和价值。方法：回顾性分析2006年3月～2009年6月我科收治的52例腰椎退变性不稳症患者,采用B-twin融合器进行后路椎间融合手术,共融合52例56个椎间隙。对所有病例术前、术后复诊时的JOA评分、椎间隙高度及融合情况进行评价。结果：随访时间8～18个月,平均12个月,52例患者术前JOA评分5～9分,平均7分,术后１周JOA评分15～22分,平均19分,末次随访19～26分,平均22分,术后、末次随诊与术前比较JOA评分差异有显著性（P<0.01）。其中显效36例,有效12例,无效4例,显效率69.23％。术前椎间高度7.5～11mm,平均8.0mm,术后9.5～13mm,平均11.5mm,末次随诊9.0～12.5mm,平均11mm,术后、末次随诊与术前比较椎间高度差异有显著性 （P<0.05）;动力位X线片显示腰椎融合率78.６％,B-twin下沉率21.２%,未发现B-twin移位。结论：B-twin融合器用于治疗腰椎不稳症短期疗效确切,需警惕假体下沉、腰背部僵硬等并发症发生。     

USS钉棒系统内固定结合椎体间植骨融合术治疗退行性腰椎不稳症

目的探讨USS钉棒系统内固定结合椎体间植骨融合术治疗退行性腰椎不稳症的疗效。方法对78例退行性腰椎不稳症患者采用USS钉棒系统内固定结合椎体间植骨融合术治疗。采用Oswestry功能障碍指数与JOA下腰痛评分对患者手术前和术后1年随访期进行评分;摄片观察植骨融合情况并统计术后内固定失败（钉棒松动、折断）的发生率。结果 6例术后出现顽固轻微手术区胀痛。所有患者均得到随访,时间13~36个月。术后3个月患者腰背痛明显缓解,术后半年基本可以恢复正常日常生活。随访期内无钉棒松动、折断发生。术后6~8个月骨性融合。术后1年,Oswestry功能障碍指数较低,JOA下腰痛评分较高,与术前比较差异有统计学意义（P〈0.05）。腰椎功能改善总有效率达100%。结论 USS钉棒系统内固定结合椎体间植骨融合术治疗退行性腰椎不稳症临床疗效满意。     

通用型脊柱内固定系统治疗腰椎滑脱

目的探讨国产通用型脊柱内固定系统手术治疗腰椎滑脱的疗效。方法采用椎板开窗减压或保留棘突的全椎板切除减压，国产通用型脊柱内固定系统（All Fix或GSS-Ⅱ）固定，椎体间植骨融合术治疗腰椎滑脱45例。结果19例完全复位，26例部分复位。术后随访39例，随访时间平均3．5年，优良率84．6％。结论国产通用型脊柱内固定系统结构简单，操作方便，固定坚固，能使滑脱的椎体复位，明显提高脊椎融合率。     

Recent advances in the treatment of low back pain

Summary There is at the present time an epidemic of low back pain in the industrialized countries. Although the exact origin of such pain is still unknown, there is increasing awareness that the outcome is usually favourable. Only some 10% of those suffering an acute episode of back pain are incapacitated for more than 6 weeks. The causes of long standing back pain are being identified in an increasing number of patients. They include anatomical and pathological disturbances in the motion segment as well as psychological, social and political causes. There are numerous factors which influence the pathophysiology of the motion segment. The degree of loading has been successfully measured and delineated for various postures and exercises, including those at work. The nutritional pathways to the disc have been established and the effect of various external factors measured. Movement is good for the disc and the importance of continuous passive motion for the healing of diseased or injured connective tissues is now established. Activation of large muscle groups increases the production of the body's pain reducing encephalins. Early diagnosis and early mobilisation of the patient should be of benefit, and long term bed rest and inactivity must be prevented. Fewer cases will need operation in the future. Improved imaging techniques and better methods of operation and fixation will help those few who have a definite pathological lesion amenable to surgery.Current trends lecture SICOT 1984     

经前路椎间融合器治疗腰椎失稳症

目的:探讨经前路应用椎间融合器(cage)治疗腰椎失稳症的适应证、技术要点及效果。方法:选择21例经临床诊断存在严重腰痛的患者实施前路椎间盘摘除和cage置入椎间融合术,并进行术前和术后影像学评价及JOA评分。结果:所有患者术后即时X线片显示手术节段椎间隙增宽、根管扩大、脊柱生理曲度恢复,腰腿痛症状缓解或消失。随访6~24个月(平均18.6个月),动态X线检查显示融合节段稳定,JOA评分从术前平均9.5分提高到术后23.5分(P<0.01)。结论:前路应用cage行椎间融合固定术具有提供生物力学稳定性和恢复脊柱生理平衡的优势,是治疗腰椎失稳症的一种安全、有效的手术方式。     

The role of radiofrequency in the treatment of mechanical pain of spinal origin

Radiofrequency (RF) ablation is a method that has been gaining popularity over the past few years among spinal surgeons. It has a role when dealing with pain of spinal origin, either mechanical or neuropathic, after conservative treatment has failed. In the present study, 122 patients with a minimal follow up of 1 year were examined at our institution after having undergone RF heat lesion of the medial branch for mechanical spinal pain (low back pain, thoracic pain or cervical pain). They were followed up 1, 3, 6 and 12 months after treatment. Twenty-two of them were additionally followed up at 18 months. After 1 month, 91 patients (75%) were satisfied with the results. After 3 months, 87 patients (71%) had significant pain relief, while in 35 patients (29%) there was no improvement. After 6 months of follow-up, 80 patients (66%) had pain relief and in 42 patients (34%) there was no effect. At 12-months follow-up, 77 patients (63%) showed good results and 45 patients (37%) had no effect. In the case of the 22 patients who were followed for 18 months, all showed significant pain relief. Minor complications occurred in 27 patients (22%), who had transient discomfort and burning pain. We concluded that RF is a safe and partially effective procedure for mechanical back pain.     

经椎间孔脊柱内窥镜系统治疗椎间盘源性腰痛

目的探讨经椎间孔脊柱内窥镜系统(TESSYS)治疗椎间盘源性腰痛(DLBP)的疗效及其预后影响因素。方法回顾性分析2012年1月—2015年12月在本院脊柱外科就诊的慢性腰痛患者临床资料,按照入选标准,共58例DLBP患者入选,均接受TESSYS治疗。患者手术前后的腰痛情况和腰椎功能用疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评估,评估末次随访时疗效用改良MacNab标准。结果所有患者随访6~48个月,平均24.5个月。患者术前腰痛VAS评分为(6.8±2.3)分,术后即刻为(3.5±1.4)分,末次随访为(1.2±0.9)分,各时间点间差异均有统计学意义(P0.05);术前ODI为(33.7±3.6)%,术后即刻为(18.6±2.9)%,末次随访为(9.3±1.8)%,各时间点间差异均有统计学意义(P0.05)。52例患者术中可见散在炎性病灶,其中22例仅有纤维环破口处炎性灶,另30例尚有硬膜囊腹侧、后纵韧带表面散在炎症灶,且对炎性病灶刺激后可以复制疼痛。此52例患者末次随访时临床疗效优良率为78.8%,显著高于余6例患者的33.3%,差异有统计学意义(P0.05)。结论 TESSYS是治疗DLBP的有效手段,术中对纤维环破口处、椎管内后纵韧带和硬膜囊等椎间盘外组织上的炎性病灶的热凝处理,可以提高疗效。     

椎间盘源性腰痛的临床特点与治疗

目的:探讨椎间盘源性腰痛的临床表现特点,为其诊断和治疗提供参考。方法:回顾性分析经手术治疗的21例椎间盘源性腰痛患者的术前临床表现、影像学资料及术后腰痛和功能改善程度。结果:椎间盘源性腰痛的主要临床表现为伴有功能障碍的严重腰痛,可伴随腹股沟、大腿前外侧痛或根性放射痛;病变椎间盘造影纤维环破裂明显,MRI上出现椎间盘纤维环后方高信号或终板信号改变者比率低;前路椎间盘切除、椎间融合术后疼痛VAS评分和Oswestry功能障碍指数改善率分别为(82.2±3.4)%和(74.0±5.7)%。结论:椎间盘源性腰痛患者的特异性体征和影像表现少,椎间盘造影是可靠诊断方法,前路椎间盘切除椎间融合疗效可靠。     

椎间盘源性腰痛的诊断与治疗

目的探讨腰椎间盘源性疼痛的诊断方法及采用前路经腹膜外入路椎间盘切除人工椎间盘置换或椎间cage植骨融合的临床疗效。方法35例经保守治疗无效的椎间盘源性腰痛患者接受手术治疗。椎间盘源性腰痛的诊断标准为：（1）腰部及下肢疼痛的部位与神经根定位不符；（2）症状反复发作，病程在半年以上；（3）MRI病变椎间盘T2加权像低信号；（4）椎间盘造影阳性，相邻节段为阴性对照；（5）关节突关节封闭除外关节突关节退变引起的疼痛。患者年龄25-67岁，平均43．6岁。L4-5 14例，L5S1 16例，L4-5和L5S1双间隙5例。前路经腹膜外入路椎间盘切除后行人工椎间盘置换13例16个椎间盘，椎间cage融合22例24个椎间盘。术后3-7天下地活动。腰围固定3个月。结果所有患者随访6～26个月，平均18个月。术后腰痛及下肢痛症状明显缓解，均恢复正常生活或工作。VAS评分由术前平均72分，降至术后18分，随访6个月时6．5分。ODI评分由术前平均21．5分。降至随访6个月时3分。椎间隙高度从术前平均9．5mm增加至术后13．5mm。手术时间70-120min，出血量100-400ml。随访时未发现肠梗阻、逆行射精和假体位置移动。结论椎间盘源性腰痛由于临床和影像学表现不典型，常被误诊或漏诊，可结合腰椎MRI及椎间盘造影进行诊断。腰椎前路椎间盘切除人工椎间盘置换或椎间cage融合是治疗椎间盘源性腰痛的有效选择。     

全身振动训练结合雷火灸治疗原发性骨质疏松症腰背痛的临床观察

目的探讨雷火灸干预原发性骨质疏松症腰背痛患者的临床疗效。方法纳入符合诊断标准的原发性骨质疏松症腰背痛患者60例,采用信封法随机分为全身振动训练结合雷火灸组(A组)和全身振动训练组(B组),每组30例。运用视觉模拟评分法(VAS)、Oswestry功能障碍指数问卷表(ODI)、Berg平衡量表(BBS)分别在治疗前、治疗4周结束时及治疗结束后1个月随访时进行评估。结果组间比较,治疗结束时及1个月随访时,VAS及ODI评分有差异(P0.05);BBS评分无差异(P0.05);组内比较:治疗结束时及1个月随访时与治疗前比较,VAS、ODI、BBS等评分均有差异(P0.05);1个月随访与治疗结束时比较VAS、ODI、BBS等评分均无差异(P0.05)。结论全身振动训练结合雷火灸在改善原发性骨质疏松症腰背痛患者VAS和ODI评分方面优于全身振动训练组,但在平衡能力改善方面两组无显著差异。     

运动员脊柱源慢性腰痛的述评

慢性腰痛一直是困扰运动员的高发病之一,其中以脊柱源慢性腰痛占多数。本文对运动员慢性腰痛的发病率及原因,康复治疗评估进行综述。通过脊柱稳定系统作为损伤的理论基础来分析目前治疗的不足,为慢性腰痛的康复治疗与评估更加适合运动员群体提供参考。     

The lumbar spine and low back pain in golf: a literature review of swing biomechanics and injury prevention

BACKGROUND CONTEXT: The golf swing imparts significant stress on the lumbar spine. Not surprisingly, low back pain (LBP) is one of the most common musculoskeletal complaints among golfers. PURPOSE: This article provides a review of lumbar spine forces during the golf swing and other research available on swing biomechanics and muscle activity during trunk rotation. STUDY DESIGN: The role of "modern" and "classic" swing styles in golf-associated LBP, as well as LBP causation theories, treatment, and prevention strategies, are reviewed. METHODS: A PubMed literature search was performed using various permutations of the following keywords: lumbar, spine, low, back, therapy, pain, prevention, injuries, golf, swing, trunk, rotation, and biomechanics. Articles were screened and selected for relevance to injuries in golf, swing mechanics, and biomechanics of the trunk and lumbar spine. Articles addressing treatment of LBP with discussions on trunk rotation or golf were also selected. Primary references were included from the initial selection of articles where appropriate. General web searches were performed to identify articles for background information on the sport of golf and postsurgical return to play. RESULTS: Prospective, randomized studies have shown that focus on the transversus abdominus (TA) and multifidi (MF) muscles is a necessary part of physical therapy for LBP. Some studies also suggest that the coaching of a "classic" golf swing and increasing trunk flexibility may provide additional benefit. CONCLUSIONS: There is a notable lack of studies separating the effects of swing modification from physical rehabilitation, and controlled trials are necessary to identify the true effectiveness of specific swing modifications for reducing LBP in golf. Although the establishment of a commonly used regimen to address all golf-associated LBP would be ideal, it may be more practical to apply basic principles mentioned in this article to the tailoring of a unique regimen for the patient. Guidelines for returning to golf after spine surgery are also discussed.