急性腰腿痛的鉴别诊断与手法治疗（附83例临床分析）

作者针对腰肌劳损急性发作合并小关节紊乱与腰椎间盘突出症所表现的神经放射症状在鉴别诊断上的难点，介绍了一整套临床鉴别诊断方法与手法治疗要点。通过３３例患者临床观察，获得很好疗效，痊愈率达８５．５％，同时还阐述了及早进行功能锻练对促进痊愈、巩固疗效和防止复发的意义。     

腰椎间盘突出致腰腿痛的现代影象学观点

腰椎间盘突出导致腰腿痛的机理可归纳为：直接的机械性压迫，间接的腰神经通道变形引起神经扭曲，纤维环破裂累及感觉神经末梢，髓核液所含高浓度的Ｈ＋及糖蛋白复合物外溢诱发抗原－抗体反应四种。前三为现代影象学所证实，为此作就最常用的非离子型造影剂椎管造影，高分辨ＣＴ和高磁场ＭＲ检查方法对椎间盘突出导致腰腿痛在影象学上的表现，诊断价值及能否相互取代进行总结。     

腰腿痛各证型CT征象研究

目的:通过对127例腰腿痛患者(腰椎间盘突出症)各证型CT表现研究,探索腰腿痛各证型CT征象的规律性。方法:对腰腿痛患者辨证以后,再行腰部CT平扫,观察、记录病变的性质、病变的部位、周围情况。对符合研究纳入标准的127例进行统计学处理。结果:气滞血瘀证、风寒湿滞证、湿热痰滞证及肝肾亏虚证在病变性质、范围上有极显著差异(P<0.05),病变部位则无显著性差异,均以L4-5及L5S1为主。结论:腰腿痛腰部CT表现可为临床辨证提供参考。并指导临床治疗和估计预后。     

腰椎间盘突出症二次手术临床分析

目的:提高腰椎间盘突出症手术治愈率,减少该病复发率。方法;收治腰椎间盘突出症第一次术后症状复发患者2 6例,根据X线,CT ,MRI,进行二次手术,了解第一次手术复发原因和二次手术方式。结果:痊愈14例;显效6例;有效3例;无效3例。结论:术后椎间盘残留复发,减压不彻底和疤痕粘连牵拉脊髓神经为主要原因。掌握手术适应证,选择合理术式,彻底切除椎间盘,扩大神经根管及腰椎管,减少术后粘连是提高腰椎间盘突出症手术疗效之关键。     

Variations in size of the bony lumbar canal in patients with prolapse of lumbar intervertebral discs.

Prolapse of the lumbar intervertebral disc is one of the commonly accepted causes of low back pain. Most patients respond well to conservative treatment, but some may not respond at all. Though the reason for this variation is not clearly understood, it is felt that a developmentally narrow spinal canal might have some relation to the persistence of backache and sciatica. The canal was therefore measured at each of the lumbar vertebral level by a method described by Jones and Thomson (1969) in 100 consecutive patients operated upon for prolapsed lumbar intervertebral discs, in 100 normal patients for comparison. This method does not give direct measurements of the bony spinal canal but provides a ratio of the size of the canal to the adjacent vertebral body. We found a trend towards the presence of a narrower than normal lumbar canal in patients with prolapsed lumbar intervertebral discs. It is concluded that in patients with prolapsed lumbar intervertebral discs necessitating operation, the canal tends to be narrower than normal, and such narrowing enhances the effect of any disc protrusion leading to severe symptoms of backache and sciatica.     

脊柱康复床治疗腰椎间盘突出症的疗效及安全性

目的分析脊柱康复床治疗腰椎间盘突出症的有效性、安全性。方法用脊柱康复床治疗60例腰椎间盘突出症患者,疗程10 d。结果 60例腰椎间盘突出症患者,经过1个疗程的治疗,其显效率为38.33%,有效率为60%,无效率为1.67%,总有效率为98.33%。结论采用脊柱康复床治疗腰椎间盘突出症有效、安全,可作为治疗腰椎间盘突出症的有效方法之一。     

双介入方法治疗腰椎间盘脱垂的临床疗效观察

目的 探讨钳取式经皮腰椎间盘切除术联合盘外胶原酶化学溶核术的双介入疗法对腰椎间盘脱垂的治疗效果.方法 用双介入方法治疗经临床及影像资料确诊的腰椎间盘脱垂患者共116例,其中男68例,女48例.急性发作期患者84例,慢性期患者32例.用双介入治疗方法治疗的患者与早期及同期用相同纳入与排除标准进行钳取式经皮腰椎间盘切除术治疗患者的疗效进行比较;对急性发作期治疗的患者与慢性期患者的疗效进行比较;对不同脱垂程度的椎间盘脱垂患者的疗效进行比较.结果 对患者分别进行6个月的随访,用Macnab标准进行疗效评价,双介入方法治疗的优良率为72.41%,高于单用经皮腰椎间盘切除术37.65%的优良率(P=0.001<0.05); 急性期患者治疗的优良率为78.57%,高于慢性期患者56.25%的优良率(P=0.016<0.05);轻度脱垂治疗的优良率为75%,高于重度脱垂患者54.17%的优良率(P=0.019<0.05).结论 双介入方法结合了2种介入治疗方法的特点,可提高椎间盘脱垂介入治疗的有效率.     

腰椎间盘高度的影像学测量

腰椎间盘高度的影像学测量,由于容易受到投照及体位等因素的影响,多年以来一直存在争议。本文对历年来几种主要的影像学测量技术手段及方法做一回顾性分析,并着重介绍了最新的测量方法。     

The use of CT scanning for the study of posterior lumbar intervertebral articulations

The spine is composed of three articular axes: one discal, two facetal. The slightest alteration in one of these axes affects the others. CT is particularly effective in demonstrating biochemical alternations due to architectural pathologies of the column. A judicious therapeutic approach is suggested.     

Diurnal T2 value changes in the lumbar intervertebral discs

AIM: To investigate if there is any in vivo diurnal T2 value changes in the nucleus pulposus in normal and degenerated lumbar intervertebral discs. MATERIALS AND METHODS: Eighteen volunteers (16 men, two women) with no symptoms related to lumbar disease were imaged in the morning before beginning daily work and in the evening after finishing work. Sagittal fast spin-echo T2-weighted images were obtained, following spin-echo transverse imaging for T2 analysis. RESULTS: The normal disc group (n=71) showed statistically significant diurnal T2 value changes (p<0.001), whilst the degenerating disc group (n=19) showed no significant diurnal changes. The normal disc group up to age 34 years showed statistically significant diurnal T2 value changes. However no significant changes were demonstrated after the age 35 years. CONCLUSION: Statistically significant diurnal T2 value changes in the normal lumbar intervertebral discs were demonstrated. Disappearance of the diurnal T2 value changes in the normal discs after the age 35 years was revealed for the first time and thought to be an aspect of aging, not caused by degeneration.