两种不同微创方法治疗老年腰椎间盘突出症的疗效比较

目的比较经皮椎间孔镜(PTED)和Quadrant微创通道下手术治疗老年腰椎间盘突出症(LDH)的临床疗效。方法收集30例单节段老年LDH手术患者,其中PTED组14例,Quadrant组16例。分析两组手术时间、切口长度、失血量、住院天数和手术并发症。采用视觉疼痛模拟评分(VAS)、Oswestry功能障碍指数(ODI)及改良MacNab标准评价手术疗效。结果 PTED组与Quadrant组相比手术切口更小,术中出血量更少,住院天数更少(P0. 05);术后两组腿痛VAS、ODI评分均显著改善(P0. 05),而Quadrant组术后腰痛VAS改善不明显;两组术后1 w、1个月腿痛VAS和ODI评分差异无统计学意义(P0. 05);两组改良MacNab标准评定的优良率和并发症发生率差异无统计学意义(P0. 05)。结论 PTED和Quadrant微创通道术式治疗老年LDH均能取得满意临床效果,但PTED手术恢复快、创伤更少。     

探讨糖尿病对腰椎间盘突出症经皮椎间孔镜下椎间盘切除术后疗效的影响

目的探讨糖尿病对腰椎间盘突出症经皮椎间孔镜下椎间盘切除术后疗效产生的影响。方法选择2018年1月—2019年12月在该院诊治的64例腰椎间盘突出症患者作为研究对象,并根据患者是否存在糖尿病划分为观察组(患有糖尿病22例)及对照组(未患糖尿病42例)。所有患者均行经皮椎间孔镜下椎间盘切除术治疗,对两组手术时间、术中出血量、住院时间、术后6个月腰椎功能障碍指数(ODI)评分以及并发症发生情况进行对比。结果观察组的手术时间、术中出血量、住院时间均高于对照组,差异有统计学意义(P0.05);术前,两组ODI评分差异无统计学意义(P0.05),术后6个月,两组ODI评分均低于术前,差异有统计学意义(P0.05),且观察组的ODI评分高于对照组,差异有统计学意义(P0.05);观察组的并发症发生率高于对照组,差异有统计学意义(P0.05)。结论经皮椎间孔镜下椎间盘切除术是治疗腰椎间盘突出症的有效方法,但糖尿病对患者术后疗效会产生一定的影响,故临床应对患者糖尿病进行有效控制。     

Zessys椎间孔成型术与传统椎间孔成型术治疗远处脱垂型腰椎间盘突出症的临床疗效比较

目的比较Zessys椎间孔成型术与传统椎间孔成型术治疗远处脱垂型腰椎间盘突出症的临床疗效。方法选择2017-08~2019-02漯河医学高等专科学校第二附属医院收治的34例远处脱垂型腰椎间盘突出症患者的临床资料,其中17例采用Zessys椎间孔成型术治疗(A组),另17例采用传统椎间孔成型术治疗(B组)。比较两组手术时间、透视次数、术中出血量,并比较两组术前、术后第3天、术后第6个月患者的疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分、日本骨科协会评估治疗分数(JOA)评分。结果A组手术时间短于B组,术中透视次数少于B组,差异有统计学意义(P<0.05)。两组术中出血量比较差异无统计学意义(P>0.05)。两组术后第3天、第6个月的VAS、ODI评分显著低于术前(P<0.05),JOA评分显著高于术前(P<0.05);但两组在术前及术后不同时间点的VAS、ODI、JOA评分比较差异均无统计学意义(P>0.05)。结论与传统椎间孔成型术比较,Zessys椎间孔成型术在治疗远处脱垂型腰椎间盘突出症中可缩短手术时间,减少术中医患X线暴露,值得推广。     

显微镜下微创椎间盘取出术治疗腰椎间盘突出症疗效观察

目的评价显微镜下微创椎间盘取出术治疗腰椎间盘突出症的手术效果。方法选择腰椎间盘突出症患者410例,均行择期显微镜下微创腰椎间盘取出术。于术前、术后3个月、术后12个月分别行疼痛视觉模拟评分(VAS);采用日本骨科协会腰椎神经功能(JOA)评分评估神经功能缓解程度,采用Oswestry量表ODI指数评估生活质量。随访6~24个月,采用Epstein法以手术优良率评价临床疗效。结果 410例患者手术时间为50~90(66.0±5.3)min,术中出血量为10~40(30.0±6.5)m L,术中出现脑脊液漏3例,无神经损伤者。410例患者均获得随访,术后3、12个月VAS、JOA评分及ODI指数均优于术前(P均<0.05)。手术优良率为91.2%。随访中出现椎间盘突出症复发8例。结论显微镜下微创椎间盘取出术治疗腰椎间盘突出症术中出血少,手术时间较短,对神经及骨性结构损伤较小,手术并发症少。     

经皮椎间孔镜与椎板开窗手术治疗复发性腰椎间盘突出症的临床效果比较

目的比较经皮椎间孔镜与椎板开窗手术治疗复发性腰椎间盘突出症的临床效果。方法选取在该院就诊的复发性腰椎间盘突出症患者82例,按手术方式不同分为两组,各41例。对照组实施椎板开窗髓核摘除术,观察组实施经皮椎间孔镜治疗,比较两组临床疗效。结果观察组手术时间、术后卧床时间、住院时间较对照组明显缩短,术中出血量减少,差异有统计学意义(P0.01);两组患者手术前后视觉模拟评分(VAS)及功能障碍指数(ODI)评分比较,差异无统计学意义(P0.05)。结论经皮椎间孔镜与椎板开窗手术治疗复发性腰椎间盘突出症效果相似,但经皮椎间孔镜治疗可缩短手术时间、术后卧床时间及住院时间,减少术中出血量。     

椎间盘镜手术治疗腰椎间盘突出症疗效观察

目的观察椎间盘镜手术治疗腰椎间盘突出症的疗效。方法将50例腰椎间盘突出症患者随机分为对照组和观察组（各25例）,对照组采用传统手术治疗,观察组采用椎间盘镜手术治疗,观察比较两组的手术时间、术中出血量、疗效、术前术后2周VAS评分及术后1周血清乳酸脱氢酶（LDH）、血清肌酸激酶（CK）、IL-6、C反应蛋白（CRP）、血沉（ESR）水平。结果观察组的手术时间与对照组相近（P〉0.05）,其术中出血量少于对照组、优良率高于对照组、术后2周VAS评分优于对照组（P均〈0.05）,其血清LDH、CK、IL-6、CRP、ESR低于对照组（P均〈0.05）。结论椎间盘镜手术治疗腰椎间盘突出症综合效果优于传统手术。     

改良 TLIF 钉棒固定术治疗胸、腰段椎间盘突出症疗效观察

目的探讨经后外侧切除关节突关节入路行椎管减压椎间孔融合(TLIF)钉棒固定术治疗胸、腰段椎间盘突出症的疗效。方法对18例胸、腰段椎间盘突出症患者采用经后外侧切除关节突关节入路行TLIF钉棒固定术。术后3、6个月评价手术效果。结果 18例患者均顺利完成手术,手术时间(110.3±19.5)min,术中出血量(265.7±47.3)m L。术后未出现切口感染、血肿、融合器脱落、钉棒断裂等并发症。术后疼痛视觉模拟评分(VAS)、欧式失能指数(ODI)评分、腰椎功能评分(JOA评分)明显低于术前(P均<0.05)。术中发生硬膜囊撕裂1例,予及时修补,无1例出现双下肢神经症状。术后6个月胸、腰段椎体融合率为89.5%(17/19);JOA评分改善率为77.1%±11.4%。结论后外侧切除关节突关节入路TLIF钉棒固定术治疗胸、腰段椎间盘突出症疗效确切,且较为安全。     

经椎间孔椎体间融合术治疗复发性腰椎间盘突出症疗效观察

目的：观察经椎间孔椎体间融合术治疗复发性腰椎间盘突出症的临床疗效。方法44例复发性腰椎间盘突出症患者,行经椎间孔椎体间融合术,采用下肢疼痛VAS、ODI评分和腰椎JOA评分进行术后临床效果评估。结果手术时间（134．9±44．1）min,估计出血量（386．6±199．1）mL,住院时间（13．0±3．8）d,随访（7．7±4．7）个月。术后出现脑脊液漏6例,一过性单侧肌力下降2例,随访时均有所恢复。与术前比较,随访时下肢VAS、ODI评分降低,腰椎JOA评分升高,P均＜0．01。结论经椎间孔椎体间融合术治疗复发性腰椎间盘突出症有效。     

单侧经椎间孔椎体间融合术与后路腰椎椎体间融合术治疗中老年椎管狭窄患者的疗效对比

目的 评估经椎间孔椎体间融合术(TLIF)在椎管狭窄治疗中的临床效果.方法 椎管狭窄患者58例分别采用TLIF和后路腰椎椎体间融合术(PLIF)治疗,通过比较手术各项指标和术后Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)及Prolo评分,评价TLIF手术的临床效果.结果 TLIF组手术切口、手术时间、术中失血、住院时间及术后并发症的发生均明显小于PLIF组(P＜0.05);TLIF组融合率达94.29％明显高于PLIF组(P＜0.05);TLIF组优良率为91.43％,PUF组为82.61％;两组术后3个月ODI及VAS评分均明显优于术前(P＜0.05);术后3个月TLIF组ODI及VAS评分明显优于PLIF组(P＜0.05);两组术后6、12个月的ODI及VAS评分均明显优于术后3个月(P＜0.05).结论 TLIF手术在椎管狭窄治疗中的临床效果明显优于PLIF手术.     

融合与非融合治疗腰椎滑脱症并椎间盘突出症

目的探讨融合与非融合固定联合治疗腰椎滑脱症合并邻近节段椎间盘突出症的临床疗效。方法采用融合与非融合固定治疗腰椎滑脱症合并邻近节段椎间突出症患者25例,术后患者获得6~36个月的随访,采用视觉模拟评分法（VAS）及腰椎功能障碍指数（ODI）评定术后疗效。结果术后无感染、神经根损伤、脑脊液漏等并发症发生。患者手术前后的VAS及ODI分值改变有统计学意义（P〈0.01）。结论融合与非融合固定治疗腰椎滑脱症合并邻近节段椎间盘突出症减压效果明显、固定可靠,有效减缓了相邻椎间盘退变,是治疗该退变的一种有效方法 。     

Comparison of the clinical efficacy of percutaneous transforaminal endoscopic discectomy and traditional laminectomy in the treatment of recurrent lumbar disc herniation

A few years ago, percutaneous transforaminal endoscopic discectomy (PTED) began to prevail in clinical treatment of recurrent lumbar disc herniation (RLDH), whereas traditional laminectomy (TL) was treated earlier in RLDH than PTED. This study aimed to compare the clinical efficacy of PTED and TL in the treatment of RLDH.Between November 2012 and October 2017, retrospective analysis of 48 patients with RLDH who were treated at the Cancer Hospital, Chinese Academy of Sciences, Hefei and Department of Orthopaedics, Second Affiliated Hospital of Anhui Medical University. Perioperative evaluation indicators included operation time, the intraoperative blood loss, length of incision and hospitalization time. Clinical outcomes were measured preoperatively, and at 1 days, 3 months, and 12 months postoperatively. The patients’ lower limb pain was evaluated using Oswestry disability index (ODI) and visual analog scale (VAS) scores. The ODI is the most widely-used assessment method internationally for lumbar or leg pain at present. Every category comprises 6 options, with the highest score for each question being 5 points. higher scores represent more serious dysfunction. The VAS is the most commonly-used quantitative method for assessing the degree of pain in clinical practice. The measurement method is to draw a 10 cm horizontal line on a piece of paper, 1 end of which is 0, indicating no pain, which the other end is 10, which means severe pain, and the middle part indicates different degree of pain.Compared with the TL group, the operation time, postoperative bed-rest time, and hospitalization time of the PTED group were significantly shorter, and the intraoperative blood loss was also reduced. These differences were statistically significant (P < .01). There were no significant differences in VAS or ODI scores between the two groups before or after surgery (P > .05).PTED and TL have similar clinical efficacy in the treatment of RLDH, but PTED can shorten the operation time, postoperative bed-rest time and hospitalization time, and reduce intraoperative blood loss, so the PTED is a safe and effective surgical method for the treatment of RLDH than TL, but more randomized controlled trials are still required to further verify these conclusions.     

Comparison of microendoscopic discectomy and percutaneous transforaminal endoscopic discectomy for upper lumbar disc herniation: A protocol for a systematic review and meta-analysis

Background:Microendoscopic discectomy (MED) and percutaneous transforaminal endoscopic discectomy (PTED), as two alternative surgical techniques in minimally invasive spine surgery (MISS), are widely conducted in the treatment of upper lumbar disc herniation (ULDH). This study will systematically assess and compare the clinical outcomes of MED and PTED in treating ULDH combining with the meta-analysis.Methods:All the randomized controlled trials (RCTs) will be searched at the databases including PubMed, EMBASE, Cochrane Library and Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP), and WANFANG Database from inception to December 2025. The primary outcome will involve Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and visual analog scale (VAS) scores. The secondary outcomes will be the short-form 36-item (SF-36) health survey questionnaire and the modified MacNab criterion. We will perform data synthesis, subgroup analysis, sensitivity analysis, meta-regression analysis, and the assessment of reporting bias using RevMan 5.3 software.Results:This systematic review will comprehensively evaluate the clinical outcomes of comparison of MED and PTED in the treatment of ULDH and provide a reliable and high-quality evidence.Conclusion:The conclusion of this study will elucidate the clinical outcomes of MED compared with PTED and clarify whether PTED generates better clinical effects than MED in treating ULDH.PROSPERO registration number:CRD 42021244204     

悬吊核心肌群训练治疗腰椎间盘突出症的临床疗效观察

目的观察悬吊核心肌群训练治疗腰椎间盘突出症的临床疗效及其对竖脊肌、多裂肌积分肌电值(iEMG)的影响。方法选择2018-01~2020-11吉林省一汽总医院康复医学科收治的64例腰椎间盘突出症患者,采用随机数字表法将其分为观察组和对照组,每组32例。对照组采用常规康复治疗,观察组在对照组治疗方案基础上增加悬吊核心肌群训练。比较两组治疗前及治疗后4周的竖脊肌iEMG、多裂肌iEMG、视觉模拟评分量表(VAS)评分和日本骨科协会(JOA)下背痛评分。结果治疗前两组患侧和健侧的竖脊肌、多裂肌iEMG比较差异无统计学意义(P>0.05)。治疗4周后,观察组患侧竖脊肌和多裂肌的iEMG显著大于对照组(P<0.05),且与同组健侧比较差异无统计学意义(P>0.05)。与治疗前比较,治疗4周后两组VAS评分显著降低,JOA下背痛评分显著升高(P<0.05),且观察组VAS评分显著低于对照组,而JOA下背痛评分显著高于对照组(P<0.05)。结论悬吊核心肌群训练有利于腰椎间盘突出症患者恢复肌力,疗效显著。     

唑来膦酸与鲑鱼降钙素治疗PKP术后骨质疏松症的疗效比较

目的比较唑来膦酸与鲑鱼降钙素治疗经皮椎体后凸成形术(PKP)术后骨质疏松症的疗效。方法选择郑州大学第二附属医院102例骨质疏松性椎体压缩骨折患者,随机分为唑来膦酸组(n=52)和鲑鱼降钙素组(n=50)。唑来膦酸组接受PKP手术和唑来膦酸治疗,鲑鱼降钙素组接受PKP手术和鲑鱼降钙素治疗。比较两组患者术前及术后椎体骨密度(BMD)T评分、视觉模拟疼痛量表(VAS)评分、Oswestry功能障碍指数问卷表(ODI)评分、椎体高度、相邻椎体再骨折的发生率及相关并发症。结果两组患者术后椎体BMD T评分均比术前增高,且在术后6、12、24个月唑来膦酸组高于鲑鱼降钙素组,差异有统计学意义(P<0.05)。两组患者术后的VAS评分、ODI评分均比术前改善,且在治疗后1、3、6个月鲑鱼降钙素组优于唑来膦酸组,差异有统计学意义(P<0.05)。两组患者术后的椎体高度均较术前有明显恢复,差异有统计学意义(P<0.05),两组之间差异无统计学意义(P>0.05)。治疗期间,两组之间相邻椎体再骨折的发生率差异无统计学意义(P>0.05),其他相关并发症差异无统计学意义(P>0.05)。结论PKP术后的骨质疏松症患者应用唑来膦酸的抗骨质疏松治疗效果更好,鲑鱼降钙素的镇痛效果更好。     

Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion under intraoperative neuromonitoring: A case report

Introduction:Traditional open discectomy and intervertebral fusion surgery is the common strategy for lumbar disc herniation (LDH). However, it has the disadvantages of long recovery time and severe paravertebral soft tissue injury. Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion (ZELIF), as a novel minimally invasive surgical technique for LDH, has the advantages in quicker recovery, less soft tissue destruction, shorter hospital stays and less pain. We report a novel technique of ZELIF under intraoperative neuromonitoring (INM) for the treatment of LDH.Patient concerns:A 51-year-old male presented to our hospital with left lower extremity pain and numbness for 1 year.Diagnosis:Lumbar disc herniation (LDH).Interventions:This patient was treated with Zina percutaneous screw fixation combined with endoscopic neural decompression, endplate preparation, and intervertebral fusion through Kambin''s triangle. Each step of the operation was performed under INM.Outcomes:The follow-up period lasted 12 months; the hospitalization lasted 4 nights; the blood loss volume was 65 ml, and the time of operation was 266 min. INM showed no neurological damage during the surgery. No surgical complications, including neurological deterioration, cage migration, non-union, instrumentation failure or revision operation, were observed during the follow-up period. Visual Analogue Scale (VAS) score reduced from 7 to 1; the Oswestry Disability Index (ODI) decreased from 43 to 14; the EQ-5D score was 10 preoperatively and 15 at the final follow-up visit; the Physical Component Summary of the 36-Item Short Form Health Survey (SF-36) was 48 preoperatively and 49 at the last follow up visit; the SF-36 Mental Component Summary was 47 before surgery and decreased to 41 postoperatively.Conclusion:ZELIF under INM may represent a feasible, safe and effective alternative to endoscopic intervertebral fusion and percutaneous screw fixation, for decompressing the lumbar''s exiting nerve root directly with minimal invasion in selected patients.     

Wallis棘突间动态内固定治疗老年节段性腰椎管狭窄的短期临床效果

目的 探讨后路椎管减压和Wallis棘突间动态内固定治疗老年节段性腰椎管狭窄症的术后短期临床效果。方法回顾性分析2008年1月至2010年12月在解放军空军总医院行后路椎管减压、Wallis棘突间动态内固定治疗的25例腰4．5节段椎管狭窄症的老年患者。男11例,女14例;平均年龄65岁。所有患者随访期均≥6个月。记录所有患者术前、术后3天、术后1个月、术后6个月Oswestry功能障碍指数（ODI）评分及视觉模拟评分（VAS）评分,测量手术节段（腰4-5）和邻近节段（腰3-4、腰 5-骶1）椎间隙与椎间孔高度。记录所有患者术中、术后并发症。结果25例患者均在椎管减压后顺利置人Wallis系统。术中、术后未发生手术相关并发症。所有患者术后临床症状均有缓解,术后3天、1个月、6个月时ODI评分和VAS评分与术前比较,差异均有统计学意义（P〈0．01）。术后1个月、6个月邻近节段（腰3-4、腰 5-骶1）椎间隙与椎间孔高度与术后3天比较,差异均无统计学意义（P〉0．05）。结论椎管减压和Wallis棘突间动态内固定治疗老年节段性腰椎管狭窄症的术后短期随访临床效果满意,Wallis系统可有效维持手术节段椎间隙及椎间孔高度,短期随访未发现引起邻近节段明显退变。     

术后早期应用唑来膦酸对腰椎融合的影响

目的探讨唑来膦酸对骨质疏松患者腰椎融合术后植骨融合的影响。方法回顾性分析2010年1月至2011年3月因腰椎间盘退变性疾病合并绝经后骨质疏松症患者的病例资料共36例。患者均采用后路腰椎板切除减压、椎间及后外侧植骨融合、椎弓根钉棒内固定术。术后1~2周给予唑来膦酸注射液5 mg静脉滴注,同时每天补充元素钙1 000 mg和维生素D3400 U。比较术前与术后3、6、12个月时功能障碍指数(ODI)评分与骨转换生化标志物变化。比较术前与术后12个月骨密度变化。分析随访期末时的植骨融合情况。结果 36例患者均获得随访,平均年龄(63.18±6.97)岁。术前ODI评分平均为(38.36±5.95)分,术后3个月为(14.36±5.22)分,术后6个月为(9.00±6.07)分,术后12个月为(9.18±6.65)分。术后各时间点ODI评分与术前相比差异均有统计学意义(均P0.05)。术后3、6个月ODI评分持续下降,6个月达平台期,与12个月相比差异无统计学意义(P0.05)。骨转换生化标志物血清β-Ⅰ型胶原交联羧基末端肽(β-CTX)、Ⅰ型原胶原氨基端前肽(PINP)术后3个月显著降低(P0.05),6、12个月时缓慢升高,但均保持在绝经后正常范围内。术前髋部和股骨颈骨密度为(0.721±0.16)和(0.687±0.19)g/cm2,术后12个月提高至(0.746±0.16)和(0.714±0.17)g/cm2(P0.05)。34例患者获得坚实融合,2例未融合,融合率为94.4%(34/36)。结论唑来膦酸抗骨质疏松作用显著,骨质疏松患者术后早期应用唑膦酸对腰椎融合无不利影响。     

腰椎间盘突出症翻修的原因分析和应对方法

目的分析腰椎间盘突出症初次手术失败的原因,探讨翻修的应对方法和疗效。方法对2005-05以来收治的38例腰椎间盘突出症术后复发的原因进行分析,并实施翻修手术。结果翻修的主要原因为初次手术不够彻底、多间隙突出遗漏及术后出现腰椎失稳等。实施翻修手术后优28例,良6例,可3例,差1例。优良率为89.5%。结论对复发的腰椎间盘突出症实施椎间融合,后路椎弓根系统内固定术,可获得满意的疗效。     

机器人系统辅助的膝关节单髁置换术治疗老年膝关节骨关节炎的临床效果

目的 探讨机器人手术系统辅助下膝关节单髁置换术(UKA)和传统膝关节单髁置换术治疗老年患者膝关节骨关节炎的疗效。方法 选择2018年1月至2020年6月就诊于解放军总医院第一医学中心78例老年膝关节骨关节炎患者为研究对象,按照随机数表法随机分为2组,每组39例。观察组实施MAKO RIO机器人手术系统辅助下UKA,对照组实施常规膝关节单髁置换术。对比2组患者围术期情况,术后8、16、24h 2组患者视觉模拟评分法(VAS)及术后6个月美国膝关节协会评分(KSS)。结果 观察组单侧 UKA手术时间(155±22) min、术中止血带使用时间 (27±10) min、术后第2天总失血量 (476±290) ml;对照组分别为 (135±21) min、(40±9) min、(536±215) ml,差异均有统计学意义(均P<0.05)。观察组术后8、16h VAS评分分别为(3.2±1.2)、(1.8±0.8) 分,对照组分别为(4.6±1.4)、(2.3±1.1)分,差异均有统计学意义(均P<0.05)。观察组和对照组术后24h VAS评分分别为(1.1±0.3)、(1.2±0.5)分,差异无统计学意义(P>0.05)。对照组术后6个月随访患侧膝关节KSS临床评分和功能评分分别为(78±11)、(70±16)分,观察组分别为(90±6)、(79±12)分,差异均有统计学意义(均P<0.05)。结论 机器人手术系统辅助UKA能够实现微创条件下精准手术,具有良好的安全性,促进了手术患者膝关节功能改善。