脊神经节膨大所致腰退痛的诊断与治疗

目的 通过临床症状及影像学结果分析，将脊神经节膨大所致腰腿痛列为一种独立疾病。方法 本组１１例，男６例，女５例。８例表现为感觉异常为主即疼痛、麻木等。３种表现感觉运动均有异常。Ｘ线检查，１１例都有不同程度骨质增生。ＣＴ检查，间盘膨出３例，轻度椎管狭窄２例，黄韧带增生２例，正常４例。ＭＲＩ检查６例，全部行治疗，开窗手术５例，半椎板切除４例，全椎板切除２例。结果：术有访３个月～１８个月。优８例，良２例     

局部封闭＋小针刀治疗腰椎间盘突出症术后残留症状132例

腰椎间盘突出症手术后残留症状是一个比较棘手的问题。长期存在 ,影响生活和工作 ,我科 1995年初开展小针刀疗法以来 ,共收治外院和本院腰椎间盘突出症术后残留症状的患者 132例 ,给予局部封闭 小针刀治疗后症状和体征消失或减轻 ,现报告如下 :1　临床资料1.1　一般资料　 132例中 ,男 5 6例 ,女76例 ,年龄 2 0～ 6 3岁 ,平均 4 5岁。 L4 ,5节段 6 1例 ,L5S1 节段 4 3例 ,L4 ,5L5S1 二节段 2 8例 ,手术方式 :椎板开窗 86例 ,半椎板切除 35例 ,全椎板切除 11例。治疗时间 :开放手术后 3月～ 6月 76例 ,6月～ 1年 2 3例 ,1年以上 33例。1.…     

胸椎黄韧带骨化症的手术治疗

目的：对胸椎黄韧带骨化症诊断及手术治疗方法的探讨。方法：9例胸椎黄韧带骨化症患，均进行手术切除，其中累及T3、4 4个节段，T10、11 6个节段，T11、12 8个节段，主要表现为下肢麻木无力，感觉异常，胸腹部束带感。经后路切除椎板及骨化灶。结果：9例随访1～49个月，平均19个月，术后优良率66．6％，1例无改善，2例加重。结论：手术是胸椎黄韧带骨化症治疗的重要手段。     

复发性腰椎间盘突出症原因分析及预防

目的 :分析复发性腰椎间盘突出症的发生原因 ,并对其预防措施及再手术方法进行探讨。方法 :对 2 0例复发性腰椎间盘突出症患者 ,通过切除残余椎板进入病变节段 ,扩大神经根管 ,摘除髓核。结果 :经平均 5年 6个月随访 ,优 12例 ,良 7例 ,可 3例 ,优良率 86 4%。结论 :对神经根管狭窄认识不足是导致腰椎间盘突出症手术失败的重要原因 ,通过切除残余椎板进入病变节段 ,可避免硬膜囊脊神经根损伤 ,并有利于脊柱的稳定性     

腰椎间盘突出症术后复发52例分析

198 4年 1月～ 1998年 6月我院与华西医科大学第一附属医院骨科收治腰椎间盘突出症术后复发再手术者 5 2例 ,本文就 5 2例再手术中所见的各种病理表现 ,分析术后复发的原因 ,并探讨预防复发的措施。1　临床资料1 1　一般资料　本组 5 2例中 ,男 32例 ,女 2 0例 ;年龄 2 5～6 7岁 ,平均 46 8岁 ;术后复发时间 1天～ 10年 ;初次术后与再次手术相隔时间 2个月～ 10年 ;手术方式 :初次手术有开窗 12例 ,扩大开窗 2 4例 ,半椎板切除 11例 ,全椎板切除 5例 ;再次手术有扩大开窗 7例 ,半椎板切除 2 9例 ,全椎板切除 16例。1 2　再次手术中所见　原…     

腰椎管狭窄症的针对性减压治疗

目的 :探讨腰椎管狭窄的手术治疗方法。方法 :根据腰椎管狭窄的因素、形式、范围和程度的不同采取不同的减压术式 :全椎板切除治疗单纯中央管狭窄 8例 ;全椎板切除 小关节部分切除治疗严重的退变性中央管狭窄伴侧隐窝狭窄 12例 ;椎板间隙潜行扩大减压治疗椎板间水平的中央管狭窄伴侧隐窝狭窄 17例 ;半椎板切除 小关节部分切除治疗中央管一侧狭窄伴侧隐窝狭窄 13例 ;椎板间开窗减压治疗单纯侧隐窝狭窄 46例。同时行间盘突出髓核摘除 63例 ,腰椎不稳侧后方植骨融合 9例 (内固定 6例 )。结果 :本组 96例 ,平均随访 2年 8个月。疗效评定优良率 82 3 %。术后继发腰椎不稳 6例 (其中全椎板切除组 2例 ) ,发生率 6 2 5 %。再狭窄 4例 ,发生率 4 17%。腰椎融合失败 1例。结论 :针对性减压治疗腰椎管狭窄症手术疗效满意 ,并可减少继发性腰椎不稳和再狭窄发生率     

后路椎板切除入路手术治疗椎管内神经鞘瘤的疗效

目的:探讨后路椎板切除入路手术治疗椎管内神经鞘瘤的临床疗效。方法:我院2005年1月~2011年1月收治71例椎管内神经鞘瘤,男39例,女32例,年龄25~99岁,平均51.6岁;颈段22例,胸段24例,腰、骶段25例,3例肿瘤位于髓内,66例位于髓外硬膜下,2例位于硬膜外。均行后路椎板切除入路手术治疗,术中57例采用半椎板切除,6例行全椎板切除,2例行多节段半椎板切除,6例行半椎板联合患侧关节突关节切除以完全暴露肿瘤组织,切除肿瘤;其中载瘤神经根与肿瘤无法分离而一并切除者9例;14例行全椎板切除或多节段半椎板切除或半椎板联合患侧关节突切除者采用脊柱内固定及植骨融合术。术后随访8~70个月,观察临床疗效,复查X线片观察脊柱稳定性及植骨融合情况,复查MRI观察肿瘤有无复发。结果:手术时间2~6h,平均3.5h;术中出血量300~800ml,平均450ml。71例患者肿瘤均获完全切除,术后均经病理检查证实为神经鞘瘤。术中无脊髓神经损伤。术后12例患者出现不同程度脑脊液漏,4例患者出现脊髓缺血再灌注损伤,给予对症治疗后康复。随访期内(8~70个月)全部患者临床症状及神经功能均有明显改善,复查MRI未见肿瘤残留或复发。14例采用脊柱内固定及植骨融合术患者植骨融合,内固定稳定。随访期间所有患者未见椎体滑脱、失稳现象。结论:后路椎板切除入路能充分暴露肿瘤,有利于完全切除肿瘤,采用此入路手术治疗椎管内神经鞘瘤临床疗效满意。     

颈椎节细胞神经瘤的临床特点与手术治疗

目的:总结颈椎节细胞神经瘤的临床特点,探讨其手术治疗效果。方法:2001年6月～2007年7月我院手术治疗颈椎节细胞神经瘤患者10例,男5例,女5例,年龄28～65岁,平均45.1岁。6例以根性疼痛为主要表现,4例以肿瘤压迫平面以下肌力下降为主要表现,3例患者有与肿瘤所在水平相关的感觉障碍平面。MRI检查显示肿瘤在T1WI呈低信号、T2WI呈高信号,增强后有强化;在轴位像上肿瘤位于髓外-硬膜内外者3例,其中2例沿椎间孔呈哑铃形生长,7例肿瘤位于硬脊膜外-椎间孔内外呈哑铃形;C1～C2水平者4例,C3～C41例,C4～C51例,C5～C63例,C4～C61例。2例肿瘤主体位于髓外-硬膜下者采用常规双侧椎板切除显露,8例肿瘤主体位于椎间孔者采用患侧半椎板-小关节突切除显露,于显微镜下行肿瘤分离切除。2例哑铃形肿瘤椎管外部分较大,附加后外侧入路切除椎旁部分。结果:肿瘤全切除9例,次全切除1例。术后病理检查可见成熟或未成熟的肿瘤性节细胞散在或成束穿插于肿瘤性雪旺氏细胞间质中,肿瘤中可见正常的神经纤维呈束状排列。术后发生脑脊液漏2例,经对症处理后治愈。术前6例神经根痛患者,术后4例症状缓解或消失,2例无变化。术前4例上、下肢运动障碍者,术后3例改善,1例无变化。随访2.1～7.2年,平均4.1年,末次随访时脊髓功能状态按McCormick分级标准评价,好转8例,不变2例。随访期间1例次全切除患者术后2年肿瘤原位硬膜下复发,再次手术切除,另9例无复发。结论:颈椎节细胞神经瘤临床上以根性疼痛及感觉运动障碍为主要表现,肿瘤形态大多数为骑跨椎间孔呈哑铃形生长,肿瘤主体多位于硬膜外。手术全切除后预后良好。     

胸椎黄韧带骨化症的手术方法选择

目的 探讨不同类型胸椎黄韧带骨化症的手术方法.方法 1994年1月至2008年6月,手术治疗56例胸椎黄韧带骨化症患者,男40例,女16例;年龄43～76岁,平均58.1岁;病程3个月至5年,平均13.4个月.通过CT及MR检查观察骨化累及节段、分布特点、骨化巢形态、椎管狭窄程度以及脊髓压迫程度等.患者均采用全椎板整块或分解切除加后外侧融合术进行治疗.术后手术疗效采用日本骨科协会(Japanese Orthopaedic Association,JOA)评分进行评价.结果 术后患者均获得随访,随访时间18～70个月,平均25个月.JOA评分由术前平均(6.25±2.47)分(0～10分)改善至末次随访时(7.53±3.20)分(0～11分).术后恢复率为-116.7%～100%;56例中优25例,良20例,可6例,差5例,优良率80.4%.CT扫描显示根据骨化巢形态胸椎黄韧带骨化分为外侧型6例,弥漫型17例,厚结节型33例.6例外侧型患者采用整块全椎板切除法,手术优良率为83.3%(5/6);弥漫型患者中,采用整块全椎板切除法11例、椎板分解切除法6例,手术优良率分别为81.8%(9/11)、83.3%(5/6);厚结节型患者中,采用整块全椎板切除法4例、椎板分解切除法29例,手术优良率分别为50%(2/4)、82.8%(24/29),并各有2例术后疗效差.结论 全椎板整块切除加后外侧融合适用于治疗外侧型、弥漫型胸椎黄韧带骨化,而全椎板分解切除法加后外侧融合适用于厚结节型胸椎黄韧带骨化.     

退行性腰椎管狭窄症椎板减压术后远期随访分析

目的 :探讨退行性腰椎管狭窄症椎板切除减压术的远期疗效。方法 :5 6例患者术后随访 6年以上 ,根据JOA标准及影像学检查进行治疗前后评定。结果 :5 6例优良率占 6 0 7% ;6 2 5 %的患者日常活动无障碍。有 4例因减压节段有椎间盘突出而再次手术。两个以上椎板切除者和术前椎体间矢状旋转角 >10°者的疗效差。结论 :治疗腰椎管狭窄症可选择单纯椎板切除减压术 ,但术前矢状旋转角 >10°并需多个椎板切除者 ,减压的同时应采用器械固定或行脊柱融合术     

Neurological outcome following laminectomy in spinal metastases

STUDY DESIGN: Retrospective outcome measurement study. OBJECTIVES: Patients suffering from malignant tumour disease and metastases to the spine develop a variety of clinical complaints including radicular symptoms and/or spinal cord compression syndromes. Palliative decompressive laminectomy with total or partial tumour resection is an acknowledged method of treatment, despite controversy. SETTING: The Department of Neurosurgery of the University of Vienna. METHOD: Patients suffering from metastases with predominant infiltration of the dorsal epidural parts, or patients who could not be operated on via an anterior approach, were included. Eighty-four patients who met these criteria underwent decompressive laminectomy with total or partial tumour removal. The study analyzed motor function, pain relief and continence in a 2- and 4-month post-operative follow-up. According to the criteria of motor performance, 20% of the patients had been mobile pre-operatively. RESULTS: In the immediate post-operative period 45%, after 2 months 33% and after 4 months 26%, were considered mobile. None of the paraplegic patients showed functional improvement. The median survival time was 6.5 months. Pre-operatively, 56% of the patients had shown continence dysfunction. Post-operatively, 38%, and after 2 months 46% of the patients, developed continence disorders. A significant reduction in analgesic medication was also observed in the post-operative period. CONCLUSION: In our series, palliative laminectomy with total or subtotal tumour reduction in patients with malignant spinal metastatic disease resulted in amelioration of motor function, pain and continence and therefore improved the patients' quality of life. The improvement in quality of life shows that this method is a valuable option in neurosurgical therapy, except for cases with pre-operative paraplegia. However, in patients with severe pre-operative paraparesis, the authors recommend laminectomy only in very exceptional cases, because of the poor post-operative neurological results.     

黄韧带骨化所致胸椎管狭窄症的诊断及手术治疗

目的：总结黄韧带骨化所致胸椎管狭窄症的诊断和治疗特点。方法：1995年9月－2000年12月手术治疗黄韧带骨化所致胸椎管狭窄症患12例，男8例，女4例，平均年龄55岁。该病常见于下胸椎，临床表现为多椎管狭窄引起的胸髓压迫症，其影像学检查具有特征性表现。所有病例均行整块半关节突全椎板切除术。结果：11例随访6－62个月，平均23个月。根据评定标准，优6例，良2例，中2例，差1例，优良率72．7％。结论：临床表现结合MRI和CT检查，是诊断胸椎黄韧带骨化的重要手段，整块半关节突全椎板切除术为治疗的有效术式。     

Combined approach to "dumbbell" intrathoracic and intraspinal neurogenic tumors

The unexpected finding of an extension of a neurogenic tumor from the thorax through the spinal foramen into the neural canal complicates its removal. Serious neurological complications may result from a two-stage approach, whether done first through the thorax or neural canal. Vertebral tomography or computed tomographic scanning reveals enlargement of a spinal foramen in advance of operation. Myelography confirms the probable presence of an intraspinal component. Four patients have been operated on using an approach designed to allow wide posterolateral thoracotomy and concomitant laminectomy for single-stage removal of the entire tumor. In 3 patients the diagnosis was schwannoma and in 1, neurofibroma. All had good results.     

Short‐term clinical observation of the Dynesys neutralization system for the treatment of degenerative disease of the lumbar vertebrae

Objective: To explore the safety and short‐term efficacy of the posterior approach of the Dynesys dynamic neutralization system for degenerative disease of the lumbar vertebrae. Methods: From March 2008 to March 2010, 32 cases of degenerative lumbar vertebral disease, 19 men and 13 women, (mean age 58 ± 5.2, range, 43–78 years), were treated with posterior laminectomy and Dynesys internal fixation. All patients had a history of over 3 months waist or leg pain that had not been relieved by conservative treatment. There were 10 cases of single lumbar intervertebral disc protrusion, 14 of degenerative lumbar spinal stenosis, 5 of degenerative lumbar isthmic spondylolisthesis, and 3 of recurrent lumbar disc protrusion after surgery. A visual analogue score (VAS) was used for pain assessment, and the Oswestry disability index (ODI) for functional evaluation of clinical outcomes. Results: All patients were followed up for 6–23 months (mean, 16.4 ± 5.5 months). Forty‐one segments in 32 patients were stabilized; 23 cases (71.9%) underwent single‐segmental stabilization, and 9 (28.1%) two‐segmental stabilization. VAS of leg pain, root and low back pain was significantly improved postoperatively. The ODI improved from preoperative 69% ± 12.6% to postoperative 28% ± 15.7% (P < 0.001). On the stabilized segment and adjacent segments above and below, the range of movement showed no statistical difference; no loosening of screws, cord and polyester spacer occurred. Conclusion: The Dynesys dynamic neutralization system combined with decompression can achieve satisfactory short‐term clinical results in lumbar degenerative disease. This procedure system not only reduces back and leg pain, but also preserves the mobility of fixed segments, minimizes tissue injury and avoids taking bone for spinal fusion.     

腰椎多节段椎间盘突出症合并腰椎管狭窄症的治疗

目的探讨应用椎板切除、髓核摘除、横突间加后外侧植骨融合、脊柱通用内固定系统（generel spinesystem，GSS）治疗腰椎多节段椎间盘突出症合并腰椎管狭窄症的手术效果。方法2004年1月-2006年1月，采用椎板切除、髓核摘除、横突间加后外侧植骨融合、GSS椎弓根螺钉内固定术治疗21例腰椎多节段椎间盘突出症合并腰椎管狭窄症患者。其中男14例，女7例；年龄46～61岁。病程8个月～15年，平均18个月。予腰椎正、侧位及过伸、过屈位摄X线片，行CT、MR／检查，均证实所有患者有多节段腰椎间盘突出症合并不同程度的腰椎管狭窄。病变间隙：L4-5，合并L5、S1 16例，L3-4合并L4-5，及L5、S15例。手术行腰椎间盘髓核摘除共47个间隙，横突间加后外侧植骨融合47个间隙。结果21例获随访1～2年，平均13个月。手术疗效根据Macnab疗效评定标准，优14例，良6例，可1例，优良率95．2％。患者主观评定满意14例，基本满意7例；未出现断钉、松动及骨不融合现象。术后复查X线片所有患者均于8～12个月骨性愈合，未见假关节形成。结论腰椎多节段椎间盘突出症合并腰椎管狭窄，采用椎板切除、髓核摘除、横突间加后外侧植骨术融合、GSS内固定，可取得良好的疗效。     

Lumbar disc herniation in patients with developmental spinal stenosis

Lumbar spinal stenosis and lumbar disc herniation are usually regarded as two pathogenetically different conditions, but in the literature lumbar disc herniation in patients with developmental spinal stenosis has been rarely documented. In a clinical retrospective study, 42 lumbar disc herniations with developmental spinal stenosis were reported and analyzed. Discectomy was performed after laminotomy. The patients were followed-up for an average of 4.4 years (range 2–7 years). The preoperative symptoms disappeared completely in 28 patients, in 13 patients some degree of backache remained although their nerve root pain had been relieved, and in 1 patient intermittent claudication reappeared after 6 years resolution of their preoperative pain. We conclude that when developmental spinal stenosis is combined with disc herniation, discectomy through laminotomy rather than laminectomy is usually sufficient for decompression.     

椎板后移回植的椎管扩大术治疗椎管狭窄症

作者报告棘突劈开、椎板后移回植的椎管扩大术治疗椎管狭窄症１８２例，使椎管容积扩大３４．８％，横径扩大３．８ｍｍ，矢径扩大６．１ｍｍ。随访２年９个月，优良率８６．６％，椎板愈合率９６．９％。本文探讨少数椎板迟延愈合的原因和预防措施，如斜切椎板、缝合固定和腰背筋膜与棘上韧带悬吊缝合等。术后卧床１０～１２周，用石膏型保护。作者认为本法能有效的预防术后脊柱不稳，顽固性腰痛等并发症。     

Spinal canal enlargement procedure by restorative laminoplasty for the treatment of lumbar canal stenosis.

BACKGROUND CONTEXT: Multilevel fenestration or laminectomy is generally performed to treat the patient with lumbar canal stenosis (LCS). However, in patients requiring laminectomy, little attention has been paid to the later development of lumbar pain possibly caused by a removal of the posterior elements of the spine. In general, spinal instrumentation and fusion has been generally performed when laminectomy might cause severe postoperative spinal instability. Surgical methods where osteotomized vertebral arches are repositioned rather than removed have long been performed. However, they have never become widespread, possibly because of the complicated surgical procedures and poor postoperative arch stability, which leads to a long period of postoperative immobilization. PURPOSE: The purpose of the present report was to introduce our surgical procedures of spinal canal enlargement using restorative laminoplasty and to report the results. STUDY DESIGN/SETTING: This retrospective study was conducted to analyze the clinical results in 33 patients with lumbar canal stenosis who had been treated by our surgical procedures of spinal canal enlargement using restorative laminoplasty. PATIENT SAMPLE: Subjects were 33 patients followed for at least 2 years after surgery. Meyerding Grade I degenerative spondylolisthesis was found in 10 patients, and degenerative scoliosis of more than 5 degrees was seen in 20 patients. Nine patients demonstrated both degenerative spondylolisthesis and degenerative scoliosis. OUTCOME MEASURES: Using the Japanese Orthopedic Association (JOA) scoring system, lumbago, sciatica, leg numbness, muscle strength and gait were quantified before surgery, 1 year after surgery and at final examination (at least 2 years after surgery) to calculate improvement rates. Furthermore, correlations to age, gender, disease duration, degenerative spondylolisthesis and degenerative scoliosis were statistically analyzed. METHODS: Our surgical procedures of spinal canal enlargement using restorative laminoplasty were performed for all patients. In our procedures, posterior elements were reapplied with an absorbable fixation (poli-L-lactic acid pins). No other fusion procedure was performed jointly. RESULTS: The mean number of restored vertebral arches was 2.2, and mean surgery time was 131 minutes. Mean volume bleeding during surgery was 328.0 ml. In all patients, successful bone healing was obtained at a mean of 5 months after surgery. Mean improvement rate for the total JOA score was 80.6%. Mean improvement rates for lumbago and sciatica were 70.0% and 87.7%, respectively. Mean improvement rate for leg numbness was 50.8%. Mean improvement rates for leg muscle strength and intermittent claudication were 70.0% and 98.9%, respectively. No significant correlation was found between gender and overall improvement rate, between age and overall improvement rate, between age and leg numbness or between number of restored vertebral arches and overall improvement rate. The tendency was that the longer the disease duration, the lower the overall improvement rate, and the more severe the residual numbness. No significant correlation was found between disease duration and muscle strength or lumbago.A significant correlation was not found between the presence of preoperative Grade I degenerative spondylolisthesis and overall improvement rate or lumbago. However, a significant difference in severity of lumbago existed between patients with degenerative scoliosis of 9 degrees and below and those with degenerative scoliosis of 10 degrees and above. CONCLUSIONS: Our surgical procedures of spinal canal enlargement using restorative laminoplasty produce complete decompression and anatomical reconstruction of the posterior elements, ligaments and muscles. Improvement in complaints of lumbago may be a consequence of the anatomical reconstruction of the posterior spinal elements. Overall, favorable results were obtained. The best results were obtained if surgery is performed within 2 years of the onset of LCS.     

后路椎板切除、椎弓根内固定治疗上颈椎哑铃形肿瘤

目的探讨后路椎板切除、椎弓根内固定治疗上颈椎哑铃形肿瘤的方法和疗效。方法对15例PUTHⅠ、Ⅱ、Ⅲ、Ⅴ型上颈椎哑铃形肿瘤患者行后路椎板切除摘除肿瘤,同时行椎弓根内固定植骨融合术。结果患者均获得随访,时间2个月~5年。术后神经功能Frankel分级:9例D级恢复至E级,3例C级恢复至D级,1例C级、1例D级及1例E级术后无改变。术后3例出现脑脊液漏,2例行腰大池引流、1例抬高床尾引流后好转;2例出现单侧肢体肌力减弱,1例出现霍纳综合征,均经康复治疗后好转。1例复发,行二次手术治疗。13例疼痛较术前有明显改善或消失,2例无明显变化。结论后路椎板切除暴露摘除肿瘤,同时行椎弓根内固定植骨融合术治疗PUTHⅠ、Ⅱ、Ⅲ、Ⅴ型上颈椎哑铃形肿瘤,可彻底切除肿瘤病灶,解除颈脊髓及神经根压迫,重建上颈椎稳定性。