腰神经根管狭窄合并椎间盘突出症的手术治疗

目的探讨腰神经根管狭窄合并椎间盘突出症的诊断，手术方法。方法 对８３例腰神经根管狭窄合并椎间盘突出症病例进行椎间盘切除并神经根管扩大术。结果 经１－６年的随访观察，优良率为９２．９％。结论根据类型选择手术方法，减压必须彻底。     

腰椎间盘突出症和椎管狭窄症手术并发症的回顾性分析

目的 回顾性分析腰椎间盘突出症和椎管狭窄症手术并发症发生的原因及对策。方法 自1992年5月～2002年5月手术治疗腰椎间盘突出症和椎管狭窄症2560例,发生并发症134例,发生率为5．23％,其中腰椎间盘突出症的并发症发生率为3.75％．腰椎间盘突出症伴侧隐窝狭窄为4．70％．单纯侧隐窝狭窄为5．13％．腰椎间盘突出症伴中央椎管狭窄为8.97％．单纯中央椎管狭窄为7．93％。器械使用不当引起的并发症为67例．其中椎板咬骨钳所致53侧．占79．1%。术后椎间盘炎8例．发生率0．3％,定位错误19例．发生率为0.74%。术后发生脑血栓2例、肺栓塞1例!2例L4全椎板切除术后发生继发性腰椎滑脱。3倒硬脊膜撕裂者术后发生脑脊液囊肿。复发性腰椎间盘突出症26例。切口血肿致神经根性放射痛12例,结果 19例定位错误者．其中15例术中纠正,4例再次手术。神经根损伤者18例,其中16例完垒恢复．马尾神经损伤者4例均不完全恢复。右髂外动脉破裂者经及时探查、修补后康复。除肺栓塞者经抢救无效死亡外,其余并发症通过处理痊愈。结论 要严格把好术前诊断、术中操作和术后处理关,以减少并发症的发生。     

腰椎椎间孔镜手术治疗伴神经根管狭窄的腰椎椎间盘突出症

目的退变性腰椎椎间盘突出、黄韧带肥厚、关节突关节增生内聚引起神经根管狭窄,利用椎间孔镜对神经根管进行减压。方法对20例退变性神经根管狭窄症患者行腰椎椎间孔镜下神经根管扩大成形术,记录术前术后腰腿痛疼痛视觉模拟量表(visual analogue scale,VAS)评分,采用Macnab标准评价疗效。结果 20例患者术前平均腰痛VAS评分为5分,术后即刻为1.5分,术后3个月为0.5分。术前平均腿痛VAS评分为7分,术后即刻为0.3分,术后3个月为0.1分。18例患者术后3个月的改良Macnab疗效评定为优,2例患者为良。结论对腰椎退变性神经根管狭窄症,椎间孔镜可对突出的腰椎椎间盘、关节突关节以及黄韧带进行减压,有效地扩大神经根管,可获得很好的疗效。     

可动式椎间盘镜技术治疗腰椎间盘突出症和椎管狭窄症

目的 探讨可动式椎间盘镜技术治疗腰椎间盘突出症和腰椎管狭窄症的疗效.方法 应用可动式椎间盘镜技术治疗腰椎间盘突出症130例、退变性椎管狭窄症60例、椎间盘突出合并椎管狭窄122例.26例有同一节段手术史.法国Bagatelle医院212例,均为单处开窗减压,双侧狭窄者潜行减压至对侧;天津医院100例,单处开窗82例、两处开窗14例、三处开窗3例、四处开窗l例,其中4例伴失稳者行镜下B-Twin椎体间融合术.根据Macnab评分标准评定疗效.结果 术后随访1～24个月,平均12个月.法国Bagatelle医院单侧手术时间平均35 min,双侧减压平均45 min;术中出血量平均35ml;术中硬膜囊撕裂1例;术后当天下床活动,平均住院1.2 d.疗效优191例,良15例,可6例;200例于术后3周内恢复原工作或牛活.天津医院单处手术平均50 min;术中出血量平均100 ml;术中转开放手术2例,定位错误4例,神经根部分损伤2例,硬膜囊撕裂4例,切口浅表感染2例;术后1～3 d下床活动,平均住院5d.疗效优80例,良15例,可5例.71例术后3周内恢复原工作或牛活.结论 可动式椎间盘镜手术器械可随意倾斜或摆动,使椎间盘切除手术操作更方便,减压彻底,效果优良.     

基于p38MAPK信号通路分析咪达唑仑对腰椎间盘突出症模型大鼠疼痛的影响CSCD

目的:探究基于p38MAPK信号通路分析咪达唑仑对腰椎间盘突出症模型大鼠疼痛的影响。方法:选取50只SPF级别SD健康大鼠,雌雄各半,随机分为正常组,模型组,低、中、高剂量组,模型组和低、中、高剂量组先建立腰椎间盘突出症模型。正常组、模型组大鼠腹腔注射生理盐水,低、中、高剂量组大鼠腹腔注射咪达唑仑,分别按30、60、90 mg/kg给药。采用酶联免疫吸检测大鼠血清中白细胞介素-1β(interleukin-1β,IL-1β)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、5-羟色胺(5-hydroxytryptamine,5-HT)、β-内啡肽(β-endorphin,β-EP)、P物质(substance P,SP)、神经肽Y(neuropeptide Y,NPY)水平,采用Western blot检测各组大鼠组织中p38 MAPK,基质金属蛋白酶3(matrix metalloproteinase-3,MMP3)蛋白表达。结果:模型组大鼠TNF-α、IL-1β、β-EP水平较正常组高,5-HT水平低于正常组(P<0.05);低、中、高剂量组大鼠TNF-α、IL-1β、β-EP水平较模型组下降、5-HT水平升高(P<0.05)。模型组大鼠较正常组SP、NPY水平上升(P<0.05);低、中、高剂量组较模型组大鼠SP、NPY水平下降(P<0.05)。模型组较正常组大鼠p38 MAPK、MMP-3表达上升(P<0.05),低、中、高剂量较模型组大鼠p38 MAPK、MMP-3表达下降(P<0.05)。结论:咪达唑仑可以改善腰椎间盘突出症模型大鼠的免疫炎症反应,可能是通过p38MAPK信号通路调控来实现的。     

成人腰椎间盘突出症与腰椎管狭窄症患者脊柱骨盆矢状面差异

目的:研究成人腰椎间盘突出症与腰椎管狭窄症患者在脊柱骨盆矢状面形态上的差异。方法 :检索2015年1月1日至2016年9月10日收治且有完整影像学资料的腰椎间盘突出症与腰椎管狭窄症患者88例,其中腰椎间盘突出症组42例,腰椎管狭窄症组46例,因年龄因素剔除22例后,腰椎间盘突出症组36例,腰椎管狭窄症组30例。测量两组脊柱骨盆矢状面形态学各指标,包括骨盆入射角(pelvic incidence,PI),骨盆倾斜角(pelvic tih,PT),骶骨倾斜角(sacral slope,SS),腰椎前凸角(lumbar lordosis,LL),胸椎后凸角(thoracic kyphosis,TK),胸腰联合角(thoracolumbar junction,TLJ),矢状面轴向垂直距离(sagittal vertical axis,SVA),矢状面轴向垂线落在骨盆的区域(sagittal vertical axis location,SVA-Location),T1脊柱骨盆倾斜角(T1-spinopelvic inclination,T1-SPI),T9脊柱骨盆倾斜角(T9-spinopelvic inclination,T9-SPI)。采用独立样本t检验对两组数据进行比较。结果:腰椎间盘突出症组的胸椎后凸角(TK)值小6°左右,P=0.031。其他参数两组差异均无统计学意义。结论:腰椎间盘突出症患者中胸椎后凸小,躯干更倾向于笔直;腰椎管狭窄患者胸椎后凸大,矢状面生理曲度更明显。     

腰椎管狭窄伴椎间盘突出症的手术选择

腰椎管狭窄伴腰间盘突出在临床上很常见,其椎管狭窄症多为退行性变引起,约占腰椎管狭窄的60%。而椎间盘退变是最常见的引发脊椎退变的病因,其中的腰间盘突出症与退行性腰椎管狭窄也常有交叉。虽然成年人椎管狭窄伴椎间盘突出而施行的全椎板切除及间盘摘除术后,很少发生明显的脊柱畸形,但其术后可能会破坏脊柱的稳定性,出现活动异常和功能单位的刚度减弱等,使术后的腰腿痛复发,影响远期疗效。因此,现代脊柱手术提出了要求保护脊柱稳定性的要求。     

老年腰椎间盘突出症合并腰椎管狭窄症特点与治疗

目的：研究老年腰椎间盘突出症合并椎管狭窄症的临床表现、影像学表现、病理解剖特点及外科治疗方法。方法：回顾分析了147例(男89例，女58例)老年腰椎间盘突出症合并椎管狭窄症患者临床表现、CT、MRI特点及病理解剖特点，病程2周～15年。病变阶段：L4.5 53例，L5S1 42例，L2,4 5例，L2,3 3例，L4,5和L5S1并存44例。全部病例采用椎板减压髓核摘除术，并对治疗方法进行分析。结果：本组92例获得随访，随访时间3个月～3年，平均8个月。术后功能按我们自己制定方法进行评定，优63例，良17例，可10例，差2例，优良率为87％。结论：老年腰椎间盘突出症合并椎管狭窄症具有临床表现不典型、症状与体征不完全一致的特点，并有其特殊的影像学表现。在治疗上应行全椎板减压，髓核摘除，扩大椎管及侧隐窝，使患者获得良好的功能恢复。     

p38 MAP kinase mediates endotoxin-induced expression of cyclooxygenase-2 in enterocytes

BACKGROUND: Necrotizing enterocolitis (NEC) occurs only after bacterial colonization of the intestine, suggesting that bacterial products, including lipopolysaccharide (endotoxin,) interact with enterocytes in the pathogenesis of this disease. Inflammatory molecules such as cyclooxygenase-2 (COX-2) are important mediators of the septic response leading to NEC. We therefore hypothesized that endotoxin activates production of COX-2 in enterocytes and explored the relative contributions of known mitogen-activated protein kinases (MAPK) pathways in this process. METHODS: IEC-6 enterocytes were treated with 5 microg/mL endotoxin, or various stresses, or media alone, and COX-2 protein levels were assayed by immunoblots with anti-COX-2 antibodies. Activation of MAPK was examined by immunoblots with phospho-MAPK antibodies. MAPK activity was blocked by treatment with pharmacologic inhibitors or transfection with dominant-negative MAPK constructs. RESULTS: Endotoxin treatment caused increased expression of the COX-2 protein 24 hours after treatment. This was preceded by rapid and transient activation of the 3 major MAPKs: extracellular-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and p38. SB203580, a specific inhibitor of p38, but not U0126 (ERK inhibitor) or SP600125 (JNK inhibitor), blocked endotoxin-induced accumulation of COX-2 protein. This response was also blocked by expression of dominant-negative p38 but not by the dominant-negative ERK construct. Genotoxic stress that activated p38 but not ERK was an effective inducer of COX-2, whereas stresses that activated both p38 and ERK were not effective. ERK inhibition by U1026 enhanced endotoxin-induced production of COX-2, consistent with negative regulation of COX-2 by ERK. These data point to p38 as the MAPK that mediates endotoxin-induced production of COX-2 in enterocytes. CONCLUSIONS: Endotoxin may be capable of inducing the production of COX-2 in enterocytes via the p38 MAPK pathway, which may be relevant to the development of NEC.     

腰椎间盘突出症和腰椎管狭窄症术后下肢麻木的发生率和影响因素

目的 探讨腰椎间盘突出症和腰椎管狭窄症减压术后残留麻木的发生率和影响因素.方法 腰椎间盘突出症和腰椎管狭窄症患者各80例,行后路减压,术后随访10天、1个月、3个月和1年.所有患者均检查神经功能和残留症状.结果 腰椎间盘突出症患者,术前76.2%患者有麻木,术后10天、1月、3月和1年分别有33.7%、25.0%、22.5%和21.3%的患者下肢残留麻木,与手术年龄、神经根直径、椎间盘突出类型和椎间盘钙化有关.腰椎管狭窄症患者,术前81.3%患者有麻木,术后10天、1个月、3个月和1年分别有42.5%、38.8%、33.7%和36.3%的患者残留麻木,与病程、术前JOA评分和椎管狭窄类型有关.结论 术后1年下肢残留麻木的发生率,腰椎间盘突出症为21.3%,腰椎管狭窄症为36.3%.推测腰椎间盘突出症患者神经组织的潜在恢复能力明显高于腰椎管狭窄症患者.     

经皮腰椎间盘切吸术治疗腰椎间盘突出症并腰椎管狭窄

经皮腰椎间盘切吸术(Automated percutaneous lum-bar discectomy,APLD)自从Hijikata首次报道成功以来,以其创伤小、出血少、不造成神经根粘连、不影响脊柱稳定性、病人易接受等优点而被广泛应用于临床,但有关APLD治疗腰椎间盘突出症并椎管狭窄的报道较少,且多数人把此类腰椎间盘症作为APLD的禁忌证.我们通过收治的45例此类腰椎间盘突出症行APLD治疗后,近期疗效满意,报告如下     

Outcomes of a prospective cohort study on peri-radicular infiltration for radicular pain in patients with lumbar disc herniation and spinal stenosis

The purpose of this study was to assess the outcome of peri-radicular infiltration for radicular pain in patients with spinal stenosis and lumbar disc herniation (LDH). Patients with spinal stenosis ( n=62) or LDH ( n=55) who met our criteria received fluoroscopically guided peri-radicular infiltration of local anaesthetic and steroid at the site of documented pathology. All the patients were followed-up at 3 months. There was a statistically significant difference in the functional outcome between the spinal stenosis group and the LDH group. The mean change in the Oswestry disability index (ODI) score for the spinal stenosis group was 5.5% compared to 12% for the LDH group. The spinal stenosis group had a mean change in visual analogue scales (VAS) of 1.2 compared to 2 for the LDH group. The higher the modified somatic perception score, modified zung depression and age at injection, the less favourable the outcome. There was a significantly better response to peri-radicular infiltration for radicular pain in patients with LDH than the spinal stenosis. Our findings help us to provide a better information for future patients. We do not know if this is a treatment effect or natural history of the pathology, as this is a cohort study and not a randomised controlled trial.     

神经病理性疼痛大鼠脊髓星形胶质细胞增殖活化的变化

目的观察神经病理性疼痛大鼠脊髓星形胶质细胞增殖活化的变化。方法健康成年雄性SD大鼠48只，随机分为假手术组和手术组（n=24），慢性坐骨神经挤压损伤（CCI）前1d、CCI后1、4、7、14、28d各随机取4只大鼠，测定机械痛阈和热痛阈后立即处死大鼠，取L4，5脊髓，用免疫组化方法观察胶质纤维酸性蛋白（GFAP）表达以反映星形胶质细胞激活情况。结果CCI后1d术侧机械痛阈和热痛阈开始下降，机械痛阈CCI后7d下降至最低，热痛阈CCI后4d下降至最低，CCI后28d仍处于较低水平（P〈0．05或0．01）；手术组术侧脊髓后角GFAP表达于CCI后4d开始增加，至CIC后7d达高峰，至CCI后28d仍维持于高水平（P〈0．05）。结论脊髓星形胶质细胞的增殖活化参与神经病理性疼痛的发生和维持。     

前路椎体骨化物复合体前移融合术治疗颈椎椎管狭窄症合并巨大椎间盘突出

目的探讨前路椎体骨化物复合体前移融合术(ACAF)治疗颈椎椎管狭窄症合并巨大椎间盘突出的临床疗效。方法回顾性分析2017年5月—2018年9月采用ACAF治疗的10例颈椎椎管狭窄症合并巨大椎间盘突出患者临床资料。对患者手术前后临床表现、日本骨科学会(JOA)评分、MRI影像学变化及并发症发生情况进行总结分析。结果所有手术顺利完成。患者术后未发生神经系统症状加重、感染等并发症;术后脊髓功能恢复显著,四肢肌力和运动功能明显改善;随访期间未发生植骨块松动和内固定失败现象。所有患者术后复查MRI,提示减压充分,T2加权像示脑脊液充盈良好,硬膜囊压迹基本消失,但高信号区仍存在。结论 ACAF治疗颈椎椎管狭窄症合并巨大椎间盘突出效果确切,可显著改善患者的神经功能。     

Association between pain sensitivity in the hand and outcomes after surgery in patients with lumbar disc herniation or spinal stenosis

Purpose

To investigate the association between pain sensitivity in the hand pre-surgery, and patient-reported outcomes (PROs) in function, pain and health pre- and post-surgery in patients with disc herniation or spinal stenosis.

Methods

This is a prospective cohort study with 82 patients. Associations between pressure-, cold- and heat pain threshold (PPT, CPT, HPT) in the hand pre-surgery and Oswestry, VAS pain, EQ-5D, HADS, and Self-Efficacy Scale, pre- and three months post-surgery; were investigated with linear regression.

Results

Patients with disc herniation more sensitive to pressure pain pre-surgery showed lower function and self-efficacy, and higher anxiety and depression pre-surgery, and lower function, and self-efficacy, and higher pain post-surgery. Results for cold pain were similar. In patients with spinal stenosis few associations with PROs were found and none for HPT and PROs.

Conclusions

Altered pain response in pressure- and cold pain in the hand, as a sign of widespread pain pre-surgery had associations with higher pain, lower function and self-efficacy post-surgery in patients with disc herniation.

     

节段性减压稳定性结构重建术治疗多节段腰椎管狭窄症合并腰椎间盘突出症

腰椎管狭窄症与腰椎间盘突出症是慢性腰腿痛的常见原因,自1997年以来作者采用节段性减压稳定性结构重建术治疗腰椎管狭窄症合并腰椎间盘突出症15例,疗效满意,现总结报告如下.     

重复注射胶原酶治疗腰椎间盘突出症

目的:探讨重复注射胶原酶治疗腰椎间盘突出症的疗效及安全性。方法:经过注射胶原酶治疗效果不理想的腰椎间盘突出症患者58例,重复注射胶原酶,观察疗效及影像学变化。L4,527例L5S131例;年龄20⁶1岁,平均42岁;男25例,女33例;病程2个月⁵年,平均3·7个月。第1次注射到本次注射的时间平均为3·8个月。结果:根据疗效评价标准优46例,良5例,可2例,差5例。46例症状体征消失,患者术后1个月复查CT,原突出的椎间盘缩小2⁶mm,平均3·4mm;余12例效果不理想的患者,术后1周复查CT,7例突出的椎间盘较术前大,5例椎间盘形态、体积无改变。此12例第3次溶盘术后其中10例症状体征消失,2例症状体征有所改善,其中1例行第4次溶盘术后症状进一步改善。27例CT显示有椎间盘出现真空征。复查CT突出的椎间盘溶解率73%,未发生过敏、感染、破坏、椎体滑脱等情况。结论:注射胶原酶治疗腰椎间盘突出症可以重复进行,适应证选择恰当可以彻底治愈此病,并且有较高的安全性。