认识颈腰椎间盘病

目的 探讨颈腰椎间盘病的特点和诊断。方法 对近６年中的颈腰椎间盘突出症伴退变性椎管狭窄症和颈椎病并施行手术的５６例进行分析。结果 发现颈腰椎间盘突出症是本病的重要原因。结论 根据临床症状、体征和影像学检查,颈椎ＭＲＩ和腰椎ＣＴ检查,是防范混淆和误诊的必要条件。     

认识颈腰椎间盘病

目的：探讨颈腰椎间盘病的特点和诊断。方法：对近6年中的颈腰椎间盘突出症、迟变性椎管狭窄症和颈椎病并施行手术的56例进行了分析。结果：发现颈腰椎间盘突出症是本病的重要原因。结论：根据临床症状、体征和影像学检查，颈椎MRI和腰椎CT检查，是防范混淆和误诊的必要条件。     

认识颈腰椎间盘病

目的　探讨颈腰椎间盘病的特点和诊断。方法　对近 6年中的颈腰椎盘突出症伴退变性椎管狭窄症和颈椎病并施行手术的 5 6例进行分析。结果　发现颈腰椎间盘突出症是本病的重要原因。结论　根据临床症状、体征和影像学检查 ,颈椎MRI和腰椎CT检查 ,是防范混淆和误诊的必要条件     

颈腰段并发椎管狭窄症12例报告

椎管狭窄症与脊髓型颈椎病和腰间盘突出症的关系已为大家所熟知,单发的颈段或腰段椎管狭窄症国内外文献已有大量报导,但颈腰段同时发病的多段椎管狭窄症尚未见报导。我院骨科从1986年10月至1990年10月从同期诊治的颈椎病和腰椎间盘突出症的病例中发现12例,由于颈腰段同时存在病变,致使颈脊髓和马尾神经根均受压迫,使症状复杂,发生误诊或漏诊,为此本文就这一新的课题加以讨论。 临　床　资　料 1　男9例,女3例,年龄48～50岁4例,51～60岁8例。 2　类型:根据发病次序和症状程度可分为几种类型。 2.1　颈椎与腰椎病症状均重者4例,颈腰椎均需手术…     

影响腰椎间盘突出症伴马尾综合征手术治疗预后的相关因素

马尾神经综合征是腰椎间盘突出症的严重并发症,以手术治疗为主。对于影响腰椎间盘突出症伴马尾综合征手术治疗预后的研究有助于指导临床对该病的治疗。本文综述了影响手术效果及疾病预后等诸多因素。患者术前症状严重、为中央型或旁中央型的椎间盘突出对术后效果的不利影响是明确的;一般认为合并椎管狭窄症、有外伤的诱因、椎间盘的突出节段、男性等因素并不影响手术的效果,手术应彻底解除马尾神经压迫或充分减压椎管。     

颈腰椎间盘病

目的： 探讨颈腰椎间盘病的特点和诊断。方法： 对近４ 年中的颈腰椎间盘突出症、退变性椎管狭窄和颈椎病并施行手术的１９ 例进行了分析。结果： 发现颈腰椎间盘突出症是本病的重要原因。结论： 根据临床症状、体征和影像学检查, 颈椎 Ｍ Ｒ Ｉ和腰椎 Ｃ Ｔ 检查, 是防范混淆和误诊的必要条件。     

胸椎管狭窄症误诊误治15例探讨

目的 总结胸椎管狭窄症误诊误治的原因及预防对策，并对治疗特点进行探讨。方法 对15例胸椎管狭窄症误诊误治和及时采取恰当手术补救的临床资料进行回顾性研究。结果 误诊为腰椎问盘突出症6例，误诊为腰椎管狭窄症7例，病变节段漏诊2例。纠正诊断后采用传统胸椎管后壁切除减压术5例、整块半关节突椎板切除术10例(其中包括加行侧前方减压术4例)，平均随访3年6个月，优8例，良5例，改善1例，差1例。结论多种因素可造成胸椎管狭窄症误诊为腰椎疾患或漏诊胸椎管的病变节段。手术原则是彻底减压和脊髓保护。     

腰椎间盘突出症术后复发的临床分析

目的探讨腰椎间盘突出症术后复发的原因及疗效。方法对1998年1月至2010年12月35例患者在本院及外院行腰椎间盘突出症术后复发再手术的临床资料进行回顾性分析。结果本组均获随访,随访时间3～52个月,平均26.8个月。效果优28例,良5例,差2例。结论误诊、漏诊,定位错误,术式选择不当,椎间盘突出髓核残留、漏切,椎管狭窄未彻底减压,节段不稳无预防性内固定,骨赘未切除,止血不彻底、暴露不清导致神经根或马尾神经损伤,椎间隙感染,术后功能锻炼不当等是腰椎间盘突出症患者术后复发的主要原因。     

复发性腰椎间盘突出症的影像学分析及临床意义

目的:探讨复发性腰椎间盘突出症的影像学特点及其临床意义。方法:回顾52例复发性腰椎间盘突出症患者的临床资料,分析其站立位腰椎正、侧位及过伸、过屈动力位X线片和腰椎MRI等影像学资料及其临床特点。结果:同节段突出36例,相邻节段突出6例,同节段突出合并相邻节段突出10例。20例存在腰椎失稳,2例合并腰椎滑脱,腰椎失稳主要发生在L4/5节段,与手术方式及椎间隙狭窄程度相关。结论:复发性腰椎间盘突出多伴有椎间隙狭窄和节段性失稳,对复发性腰椎间盘突出症的治疗要兼顾减压和稳定两个方面。     

颈腰综合征及其治疗

颈腰综合征是脊柱疾病中的疑难严重病.其概念是指颈椎与腰椎均具有发育性椎管狭窄因素,以致后天获得病理改变后同时或先后出现颈段与腰段椎管内容物受累症状.本病临床特点是既有颈脊髓受压又同时有腰神经根受压的表现.该病的颈椎病变多以脊髓型及神经根型颈椎病的形式存在,而腰段病变以腰椎椎管狭窄及腰椎间盘突出多见.当患者仅以颈段或腰段某个最主要症状就诊时,漏诊很容易发生.脊髓型颈椎病的漏诊率最高.详细的理学检查,准确的影像学资料及综合分析是减少漏诊的重要步骤.治疗包括手术治疗、保守治疗,由于多节段发病,治疗难度较大.采用中西医结合的系统的替代性康复治疗及其疗效评定是急需解决的课题.     

Cauda Equina Syndrome in Lumbar Disc Disease

A series of 42 patients with lumbar disc disease and herniation, presenting with the cauda equina syndrome, has been studied. It was observed that pure disc herniation accounted for the syndrome in five cases only. Associated structural lesions were contributory factors in the remaining 37 cases, and operative manipulation and trauma during disc removal through an interlaminar approach was the added factor in two of them. Wide laminectomy with excision of the overhanging facet joints and adequate visualization of the lumbar nerve roots has been found to be the ideal procedure for disc removal and for relief of the symptoms, including backache. No postoperative spinal instability has been observed. There was no mortality and the morbidity was insignificant. All cases have been followed up, and “good to excellent” results were obtained in 95 per cent of patients, and “fair” results in the other 5 per cent.     

一期手术治疗颈腰椎间盘病

目的：探讨一期手术治疗颈腰椎间盘病的适应证和效果。方法：对9例施行手术的颈腰椎间盘病患者的临床特点和手术结果进行分析。结果：一期手术对特定患者是安全有效的。结论：严格掌握手术适应证、熟练的手术操作、重视围手术处理是手术成功的必要条件。     

Review: Complications of Surgery For Thoracic Disc Disease

Background

Thoracic discectomy has evolved over the last 60 years from resection through standard laminectomy, to posterolateral procedures to open thoracotomy and finally thoracoscopy. Comparison of relative morbidity and mortality between these approaches is now possible.

Methods

Peer-reviewed publications reporting clinical data relating to thoracic discectomy, and which provided sufficient information to enable adequate assessment of mortality and morbidity were reviewed. These articles were determined via review of the results of MedLine searches and articles gathered through compilation of references from those articles.

Results

Articles reviewed spanned a period of over 60 years. Surgical procedures used for thoracic discectomy included laminectomy, pediculectomy, costotransversectomy, lateral extracavitary, transverse arthropediculectomy, anterolateral thoracotomy, and thoracoscopy. Complications included death, paralysis, paresis, loss of bowel and/or bladder control, pulmonary embolism, pneumonia, atelectasis, compression fracture, infection, pleural tear, bowel obstruction, and anesthesia dolorosa. Mortality dropped to nearly zero after development of anterior and posterolateral approaches. Morbidity seems relatively similar between most procedures other than laminectomy. Not enough procedures have been reported using thoracoscopy to adequately assess its morbidity.

Conclusion

Comparison of relative rates of morbidity and mortality between surgical approaches to thoracic discectomy suggest that laminectomy does not provide adequate access for the safe removal of these lesions. Choice of approach among the alternatives should be based on the evacuation of the herniated fragment and experience of the surgeon. Thoracoscopy, although promising, has not had sufficient time for evaluation of morbidity to make definite statements regarding its safety.     

A Surgical Technique for a Vertebral Column Autograft Using the Intervertebral Disc for Cervical Disc Disease

Summary We describe a surgical technique for a vertebral column autograft using the intervertebral disc for cervical disc disease for patients whose major problem is not spinal instability. Of a total of 41 patients with cervical disc disease suffering from cervical spondylotic radiculomyelopathy, 33 patients were operated on at one level and 8 patients were operated on at two levels. Postoperative X-ray film showed some movement at the “operated” disc level in all patients (average postoperative follow-up period was 43 months, range two years to 5 years). A significant decrease in motion in the extension position was observed postoperatively (p<0.0001), but no significant difference was observed between the preoperative motion and the postoperative motion in the flexion position. Anterior angulation was found in two (5%) of the 41 patients. This surgical procedure has two major advantages: 1) no complications related to the iliac donor site, allowing early patient mobilization; 2) the extensive posterior spur can be removed safely and easily under a wide operative field. We believe that this surgical procedure is suitable for preserving the mobility of the spine and may avoid stress concentration at adjacent levels of the “operated” disc. However, in patients whose major problem is spinal instability, anterior cervical fusion should be performed.     

同种异体椎间盘移植治疗颈椎间盘疾病患者围术期护理

对12例颈椎间盘疾病患者采用同种异体椎间盘移植治疗.结果 术后3～4 d在医护人员的监护下去除颈托开始颈椎活动度的训练,10～14 d出院,出院时JOA评分14.75分,颈部前屈达10°～20°、后伸10°～15°.随访2.0～5.5年,颈部前屈、后伸活动范围达6.3°～13.2°.提示同种异体椎间盘移植效果较好,术前做好心理护理、沟通训练、体位训练、上下床训练及镇痛处理,术后保持颈椎稳定度,早期进行颈椎活动度训练、肢体精细功能训练等,保证了手术的效果.     

Intervertebral Fusion with Mobile Microendoscopic Discectomy for Lumbar Degenerative Disc Disease

The aim of this article is to introduce a technique for lumbar intervertebral fusion that incorporates mobile microendoscopic discectomy (MMED) for lumbar degenerative disc disease. Minimally invasive transforaminal lumbar interbody fusion is frequently performed to treat degenerative diseases of the lumbar spine; however, the scope of such surgery and vision is limited by what the naked eye can see through the expanding channel system. To expand the visual scope and reduce trauma, we perform lumbar intervertebral fusion with the aid of a MMED system that provides a wide field through freely tilting the surgical instrument and canals. We believe that this technique is a good option for treating lumbar degenerative disc disease that requires lumbar intervertebral fusion.