经皮穿刺颈椎间盘切除术现状

早在二十世纪50年代Hult［1］就提出，通过降低椎间盘压力而不是直接切除突出的椎间盘来治疗椎间盘突出症。70年代中期，人们开始接受这个观点并运用于腰椎间盘突出症的治疗，经皮穿刺腰椎间盘切除术（PLD）获得令人满意的疗效［2］。90年代初，周义成、李健等人开始将经皮穿刺腰椎间盘的髓核切割器改良，进行经皮穿刺颈椎间盘切除术（下简称PCD），治疗颈椎间盘突出症和由颈椎间盘突出而引起的早期颈椎病。PCD的作用原理和手术方法PCD的作用原理是经过颈部皮肤软组织间隙空刺进入椎间盘，进行切割抽吸部分髓核组织，使髓核组织内压降…     

经皮穿刺切割抽吸术治疗C7～T1椎间盘突出症

目的：探索经皮穿刺切割抽吸术（puncture cervical discotomy，PCD）治疗C7-T1椎间盘突出症的穿刺方法、可行性和疗效。方法：选择3例C7-T1椎间盘突出症颈部瘦长的患者，经临床检查和MR诊断为C7-T1椎间盘突出并压迫一侧神经根，在X线透视定位下采取PCD术治疗。结果：选择3例颈瘦长体型患者，手术均安全顺利，PCD术后2个月内主要症状和体征基本消失；分别随访7、11、16个月无复发。结论：选择颈瘦长体型的单纯C7-T1椎间盘突出症患者采用PCD术治疗安全有效。     

微创治疗颈椎间盘突出37例

目的 探讨经皮穿刺颈椎间盘髓核切除术(percutaneous cervical discectomy,PCD)联合低温等离子消融术(percutaneous nucleoplasty,PCN)治疗颈椎间盘突出的临床应用.方法 在C型臂X线机引导下,选择颈部前外侧经气管、食管与颈动脉鞘之间入路,用穿刺针插入椎间盘中心,然后依次使用椎间盘旋切系统及等离子消融系统治疗颈椎间盘突出患者37例.结果 治疗37例患者,1例手术失败,有效率为80.6％;1例等离子刀头断裂,但随访无后遗症.结论 PCD联合PCN治疗颈椎间盘突出具有创伤小、痛苦少、安全性高、恢复快等特点,是治疗颈椎间盘突出的有效方法之一.     

经皮穿刺颈椎间盘切吸术治疗颈椎间盘突出症

目的：对经皮椎间盘切吸术治疗颈椎间盘突出症进行探讨。方法：通过经皮颈椎间盘切吸技术对10例颈椎间盘突出的病人进行治疗，以证实颈前区经皮穿刺插管的安全路径，并进行疗效评价。结果：10例治疗观察，均获有效其中优良率为80％，无并发症发生。结论：经歧穿刺颈椎间盘切吸术是治疗颈椎间盘突出征的有效方法。     

经皮穿刺颈椎间盘切除术的体会(附67例报告)

目的：采用经皮穿刺颈椎间盘切除术（PCD）治疗颈椎间盘突出症。材料与方法：总结经皮穿刺腰椎间盘切除术（PLD）的经验基础上，结合颈部解剖特点，成功地将PLD技术用于经皮穿刺颈椎间盘切除（PCD），并自1993年7月-1997年6月采用PCD治疗颈椎间盘突出症共67例。结果：术后综合疗效评定结果为：优49例，良7例，无变化8例。优良率为87.5%。结论：PCD与常规经颈前路椎间盘手术相比，具有创伤小，手术方法新颖，操作简单，安全可靠，患恢复快等优点。     

经皮穿刺摘除颈椎间盘治疗颈椎间盘突出

颈椎间盘突出症是临床上一种常见疾病, 自无创伤性的影像CT、MRI检查应用以来,颈椎间盘突出症进一步得到了明确诊断。以往颈椎间盘突出症的治疗,以牵引、按摩、局部用药等保守治疗为主,但一部分患者难以奏效。只:有靠外科手术治疗,外科手术创伤大,恢复慢,部分术后颈部活动受影响。继周义成报告用经皮穿刺摘除术(PCD)治     

经皮穿刺切吸术治疗外伤性颈椎间盘突出症51例

目的 探讨采用经皮穿刺切吸术治疗外伤性颈椎间盘突出症的疗效及临床意义。方法 在局麻下对51例外伤性颈椎间盘突出症患者74个椎间盘行颈前路经皮穿刺切吸术,其中男32例,女19例,年龄21-58岁。全组均为屈曲性损伤,损伤部位为C3-C7,其中中央型39例,侧方型12例。结果 50例获得3-26个月随访,平均16个月,其中显效37例,有效11例,无效2例,均系合并有较严重骨性椎管狭窄或脊髓变性,优良率为94.1%(48/51)。结论 经皮穿刺切吸术是治疗外伤性颈椎间盘突出症的有效方法,严格掌握适应证,早期减压是提高手术成功率的关键。     

经皮激光汽化减压加臭氧溶解治疗颈椎间盘突出症的观察与护理

目的探讨经皮激光汽化减压加臭氧溶解术联合治疗颈椎间盘突出症的方法和术前术后的护理要点。方法应用半导体激光、医用臭氧发生器。在X线引导下，经前路穿刺进入椎间隙中心处以自动脉冲式激光烧灼髓核，然后注入O2-O3混合气体，解除突出的椎间盘对神经根的压迫。结果观察治疗后的70例颈椎间盘突出症患者，经过精心的术前、术后护理，取得了满意的疗效。结论护理人员熟悉治疗方法和治疗原理很重要，护士根据病人不同病情采取不同的护理措施，为医生的治疗创造了良好的条件，从而确保了治疗效果。     

用CT探讨经皮穿刺颈椎间盘的安全间隙及其临床应用

本文根据29例颈部CT横断面图象的解剖特点和4例MRI的横断面、冠状面、矢状面图象所示椎骨特征,指出颈椎间盘经皮穿刺切除髓核的安全途径为颈椎间盘前外方气管与颈动脉之间的间隙。并根据不同间盘平面的解剖结构统计了安全进针的夹角,介绍了颈部经皮穿刺切割方法。根据上述安全间隙,在电视透视引导下成功地施行5例颈椎间盘突出的间盘切除,治疗效果满意。     

射频消融髓核成形术治疗颈椎间盘突出症

目的探讨射频消融髓核成形术治疗颈椎间盘突出症的安全性和疗效。方法应用射频消融髓核成形术治疗颈椎间盘突出症22例,男19例、女3例;年龄18～35岁,平均(25.5±4.5)岁。共23个椎间隙:单间隙21例,双间隙1例。术后随访近期效果。结果本组22例患者均获随访,随访时间1～12个月,平均7.6个月。显效17例,有效4例,无效1例,总有效率95.45%。结论射频消融髓核成形术是治疗颈椎间盘突出症行之有效的方法,这种技术简单、微创、安全、疗效肯定。关键是选择合适的适应证。     

Cervical epidural AVM

Summary The case of a cervical AVM with an uncommon location is reported and the diagnostic problems involved are discussed.     

Cervical Chymopapain Chemonucleolysis

Cervical chemonucleolysis probably represents the treatment of choice in case of a C6-C7 radiculalgia. This technique must be performed by specialists, given the particular anatomy which is in front of the cervical disk, within the soft tissues. For the future it is necessary to delete the manufacturer's restrictions concerning chymopapain use at the cervical level.     

Cervical lymph nodes

The lymph node staging is a very important prognostic parameter for patients with presenting with head neck cancer and is influencing the selection of the different therapeutic strategies including surgery, chemotherapy, radiotherapy or a combination of them. The accuracy of imaging techniques, such as US, MR imaging, and CT, depends on the appropriateness of radiological criteria used for diagnosing lymph node metastases. Size of nodes and evidence of necrosis are still the most important radiological criteria. However, the size shows great variability. A spherical lymph node larger than 10mm is an indicator for a malignant node, whereas an oval shape and/or a fatty hilus are more benign signs. But there are many limitations and different cut offs published in the literature, indicating that the size of a lymph node is not a reliable criteria for the assessment of lymph nodes in the head and neck region. Today new high-resolution MRI sequences and the development of specific contrast agents are offering new possibilities in the diagnostic work-up of head and neck lymph nodes. Ultrasmall superparamagnetic iron oxide particles (USPIO's) are resulting after intravenous application in a reduction of the T2 relaxation time. This is causing a signal decrease on T2-weighted MR images in benign lymph nodes after administration of USPIO's, whereas malignant lymph nodes do not show a significant signal decrease. Some clinical studies presented already very promising results. Based on the fact, that the size evaluation of lymph nodes in the head and neck has not changed during the last decade, this paper will mainly focus on MRI with new contrast agents and new techniques as diffusion weighted imaging (DWI).     

Cervical ectopic thymus

Two cases of cervical aberrant thymus in infants are reported; it's important to identify such ectopia because thymic tissue involutes spontaneously later on; neither surgery nor other treatment is needed. Ultrasonography is a method of choice for tissue characterization of ectopic thymus and differential diagnosis with other cervical masses.