对推拿无效的“腰椎间盘突出症”手术探查分析

对推拿无效的“腰椎间盘突出症”手术探查分析魏加强，天义东１９８７～１９９１年间，我院骨科用手术探查方法分析了２００例推拿治疗无效的＂腰椎间盘突出症＂，认为：１．对于突出物内容可在椎间盘与突出处来回滑动的＂活动型＂，适于推拿手法治疗。２．对于纤维环部分...     

麻醉下推拿治疗腰椎间盘突出症致马尾神经损伤

麻醉下推拿是腰椎间盘突出症传统保守治疗的一个重要手段。它主要是通过手法使脱出物与神经根相对位置的改变来减轻或解除其对神经根的压迫,从而缓解症状,达到治疗目的,但有并发马尾神经损伤之可能。本院自1986年以来在全麻下行三步八法推拿治疗腰椎间盘突出症312例,其中4例出现症状加重,并发马尾神经受压症状,均经手术证实。该并发症占推拿病例1.28%,占同期手术病例的1.79%。作者认为,防止该并发症的发生应注意:(1)中央型腰椎间盘突出症应禁忌推拿。对棘间两旁有压痛并两下肢放射痛或双下肢抬高试验阳性,怀疑中央型腰椎间盘突出症患者,应作…     

从腰椎间盘手术认识重手法推拿利弊（附25例报告）

从腰椎间盘手术认识重手法推拿利弊（附２５例报告）蒋会平，王泽强，关继华，李照明重手法推拿按摩治疗腰椎间盘突出症有的学者认为有益［１］。本院自１９８９年至今共施行１５０例腰椎间盘手术。术中发现有２５例（占１６．７％），有严重粘连。对２５例病人进行回顾性...     

腰椎间盘突出症诊治失误15例分析

自1993年以来共收治腰椎间盘突出症经手法推拿后症状加重或瘫痪的病人15例。均限期手术治疗。本组病人在手术前均经腰椎正、侧、斜位片及CT检查，术中探查确诊。病史中均有较重的手法推拿史，期间无其他外伤及特殊治疗，且推拿后立即或次日出现症状加重。     

超短波,牵引,推拿治疗腰椎多间盘突出症

大多数腰腿痛病人可通过推拿手法治愈或缓解症状。但有些腰椎多间盘突出单进行推拿手法治疗效果欠佳。自1991年10月至1995年3月，我种应用超短波，牵引、推拿手法联合治疗腰椎多间盘突出症72例，取得良好的疗效。现报告如下。1临床资料1．1一般资料（1）超短波、牵引、推拿手法联合治疗（简称治疗组）72例，男44例，女28例．年龄24～68岁．平均为37．8岁；病程1周至6年．平均为6个月。临床症床：腰椎侧弯、腰痛伴两下肢交替性淋病40例，单下肢麻痛32例，直腿抬高30～50度。影俗学检查：谁管造影．CT或核磁共振检查，诊断为腰椎多间盘突出症…     

非手术疗法治疗腰椎间盘突出症临床研究

本文介绍了腰椎间盘突出症在全麻下手法推拿的方法。对４６９例患者行非手术疗法治疗后的效果进行了分析，并对其中５９例患者推拿治疗前后的ＣＴ、体感诱发电位及血管电脑Ｂ超检查结果进行对比观察，分析手法推拿治疗腰椎间盘突出症的作用机制，提出了一种新的观点，认为推拿治疗腰椎间盘突出症并非将突出之髓核定位或挤破，而是通过手法作用在机体深部，改变突出物周围组织的血液循环，松解受压神经根与周围组织的粘连而达到治疗目的。     

手法治疗腰椎间盘突出症的临床效应分析

手法治疗腰椎间盘突出症的临床效应分析广东省南海市中医院（广东５２８０００）查和萍作者自１９９３年以来，采用腰椎牵引，悬腿压腰为主要手法治疗腰椎间盘突出症１０４例，取得显著临床疗效，现将推拿治疗的作用机理，并结合生物力学原理进行分析，作如下报告。１临床...     

自制器械经皮髓核摘除术治疗腰椎间盘突出症：（11例报告）

经皮髓核摘除术治疗腰椎间盘突出症国外已较广泛的应用于临床．取得了满意的效果．此方法主要适用于单纯突出和没有上下潜行的韧带下突出．作者采用自行设计的器械治疗腰椎间盘突出症１１例，其中优７例，良２例．讨论了此方法的手术适应症，手术要点，作用机理和并发症．     

腰椎间盘突出症合并骨化（附50例报告）

作者报告５０例腰椎间盘突出症合并骨化的临床表现病因病理和手术治疗．１９８７～１９９４年本院收治该症５０例，男２７例，女２３例，年龄２８～６４岁，平均４７岁，均经ＣＴ和手术证实．４２例腰前突消失、侧弯畸形、腰椎活动受限；４８例直腿抬高试验阳性；３５例下肢肌力减弱，其中５例足下垂．随访半年～５年，平均３年２月．结果：优２５例，良１７例，可８例．腰间盘突出症合并骨化是机体对椎间不稳的防御反应，易引起神经组织不可逆的病理变化，按摩推拿只能使神经根在硬的骨面上研磨，进一步损伤神经组织，该症一经诊断尽早手术．     

腰椎间盘突出症单元的模式与建立

腰椎间盘突出症单元是腰椎间盘突出症医疗管理的新模式,包括对腰椎间盘突出症患者进行手术治疗与非手术治疗(针灸、中药、牵引、推拿手法、支具、运动疗法、心理辅导和健康教育等)。该模式是目前腰椎间盘突出症临床治疗最为有效的方式。     

Surgical treatment of herniated intervertebral discs in children and teenagers]

The authors present early results od surgical treatment of herniated intervertebral discs in children and teenagers. Five cases of herniated intervertebral discs in the lumbar spine in teenagers were treated surgically between 2000 and 2002. The paper presents early results of surgical treatment, as well as the indications for it. It is the authors' opinion that the indications for surgery of herniated lumbar discs among children and teenagers do not differ form indications among adults. Postponing surgery because of young age seems to be unjustified.     

医源性桡神经损伤46例分析

目的阐述医源性桡神经损伤的伤因、治疗和预防措施。方法分析1991年～2003年间收治的46例医源性桡神经损伤的病例。结果伤因分为上肢手术误伤，肱骨干和桡骨上端闭合性骨折复位手法不当，头静脉穿刺致桡神经浅支损伤。本组21例保守治疗，22例手术治疗，3例行肌腱转位功能重建。结论手术误伤是医源性桡神经损伤的首要原因；临床医生丰富的解剖知识和细致、轻柔的操作是预防医源性桡神经损伤的关键。     

Chemonucleolysis in the treatment of surgical sciatica

Enzymatic dissolution of nucleus pulposus by percutaneous injection of a papain preparation is now used frequently to treat lumbosacral disc hernias responsible for resistant sciatica. Mechanisms of action and techniques are reviewed, and the importance of applying strict criteria for indications for use emphasized. The method should be reserved for nerve root sciatica resistant to medical treatment or physiotherapy, and it constitutes the last stage of conservative treatment. Exclusion criteria are mainly "excluded" disc lesions, major dysfunction or associated spinal vertebral canal stenosis. The optimal indication is represented by the subacute disc hernia in the young. This alternative to open surgery in no way compromises the results in case of failure. Results obtained in a personal series of 150 cases are analyzed comparatively with those reported in the literature.     

人工髋关节置换早期并发症分析(附36例报告)

目的探讨人工髋关节置换的早期并发症的原因及其防治。方法回顾分析了831例人工髋关节置换术病例,其中股骨头置换648例,全髋置换183例,分析了早期并发症的原因,总结其防治措施。结果36(4.3%)例出现了早期并发症,其中伤口感染3例,血肿2例,脱位2例,股骨上段劈裂5例,神经损伤1例,下肢深静脉血栓23例。结论严格手术适应证,正确手术操作,强调手术前准备、手术后处理是减少早期并发症发生的关键。     

Osteopathic manipulative medicine for carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is 1 of the most common peripheral nerve entrapment disorders. Osteopathic manipulative medicine can be invaluable in diagnosing and managing CTS. Combined with a patient's history and a standard physical examination, an osteopathic structural examination can facilitate localizing the nerve entrapment, diagnosing CTS, and monitoring the disease process. Osteopathic manipulative treatment is noninvasive and can be used to supplement traditional CTS treatment methods. The authors also review the relevant anatomy involving CTS and the clinical efficacy of osteopathic manipulative medicine in the management of this disorder.     

腰神经后支切断术治疗顽固性腰背痛22例报告

采用腰脊神经后支切断术治疗顽固性腰背痛２２例，讨论了腰神经后支的应用解剖，认为腰背痛与腰脊神经后支存在密切联系，利用腰神经后支的分布规律，从主诉痛点部位，沿受累神经自远端向近端追踪神经来源，在近端便可找到腰痛的原发部位，神经定位和后支阻滞试验为神经后切断提供了重要依据，文中详细介绍了手术方法，对手术适应提出讨论，认为该手术简单，效果确切，可达到就久止痛。     

Osteopathic manipulative treatment of a 26-year-old woman with Bell's palsy

Bell's palsy is caused by a lesion of the facial nerve and results in unilateral paralysis or paresis of the face. The condition affects approximately 23 in 100,000 persons, with onset typically occurring between the ages of 10 and 40 years. The authors report the case of a 26-year-old woman with Bell's palsy, whom they treated with osteopathic manipulative treatment that was focused on the enhancement of lymphatic circulation. The osteopathic manipulative procedures used involved reducing restrictions around four key diaphragms (thoracic outlet, respiratory diaphragm, suboccipital diaphragm, cerebellar tentorium), as well as applying the thoracic pump, muscle energy, primary respiratory mechanism, and osteopathy in the cranial field. The authors, who were guided by the four principles of osteopathic philosophy, report that the patient's symptoms resolved within 2 weeks, during which two sessions of osteopathic manipulative treatment, each lasting approximately 20 minutes, were held. Patient recovery occurred without the use of pharmaceuticals.     

突出髓核内压力在神经根受压机制中的作用

目的观察腰椎间盘突出症患者突出髓核内压力与神经根受压程度的关系。探讨突出髓核组织的临床意义及手法治疗的机理。方法选取空军总医院收治的腰椎间盘突出症手术患者30例,根据直腿抬高试验分为直腿抬高(+)性组、(-)性组,术中测量患者突出髓核内压力大小、观察突出髓核内压力与直腿抬高高度的关系。结果直腿抬高(+)性组患者突出髓核内压力明显高于(—)性组患者,具有显著意义(P<0.01)。两组患者突出髓核大小无明显差异(P>0.05)。结论1、突出髓核对神经根的压迫与突出髓核内压力有关,突出髓核内压力较大时患者直腿抬高受限,突出髓核内压力较小时直腿抬高不受限。突出髓核对神经根的压迫与突出髓核大小尚未见明显关系。2、椎管对突出髓核组织的容纳的极限与突出髓核内的压力相关,推测手法治疗可以通过降低突出髓核内压力减轻甚至解除神经根受压,达到治疗目的。     

Skipping of the ulnar nerve and the medial head of the triceps--a case report]

The authors describe rare phenomenon of the snapping of the medial head of the triceps muscle and recurrent dislocation of the ulnar nerve. The indications for operative treatment are established. The authors describe its own case making a conclusion that operative treatment is a good option in some cases.     

肘管综合征的成因和神经学检查

肘管综合征是常见的周围神经嵌压症之一。我院1990年12月—1995年12月共收治该症22例,均经严格的神经学检查和病因学分析后确诊,治疗全部行尺神经前移术。术后随访20例,平均随访2年5月,12例恢复正常,6例明显好转,2例较差。作者认为,当手部感觉改变和运动障碍为单纯尺神经损伤引起,肌电图提示尺神经传导速度在肘管部减慢,肘管内或外可找到神经受损原因,肘管综合征即可确诊;当肌电提示尺神经传导在肘管部减慢,而肘管内或外找不到神经受损原因,应高度疑诊肘管综合征。