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。     

经皮穿刺切割术治疗颈椎间盘突出症66例

经皮穿刺切割术治疗颈椎间盘突出症６６例武警江苏总队医院骨科胡玉华（扬州２２５００３）关键词经皮穿刺切割术,颈椎间盘突出症颈椎间盘突出是一种影响人们工作和生活能力的常见病、多发病,一般治疗以牵引、理疗、按摩和手术为多,但往往不理想,或有损伤神经血管等危...     

经皮穿刺颈椎间盘切除术后椎间盘炎2例报告

[编者按]椎间盘炎或椎间盘感染是PLD和PCD的严重并发症之一,国内外报道低于1％,应引起重视。本文在如何早期诊断、治疗上提供有益的经验可供借鉴,但还应该强调严格的无菌操作可减少此并发症的发生。目前研究表明术前应用能进入间盘内的抗生素,可进一步预防此并发症的发生。图1颈。椎间盘炎经再次PCD病灶清除半年后复查显示：乳,椎间隙变窄,终板硬化。图2颈。椎间盘炎病灶清除术中。圄3颈5。椎间盘炎术后3个月复查显示：椎间隙变窄,颈5椎体骨质疏松。我院自1993年起开展经皮穿刺颈椎间盘切除术（PCD）共120例。其中发生术后椎间…     

经皮椎间盘切吸术联合电热疗法治疗椎间盘突出症的护理

目的总结DSA引导下经皮椎间盘切吸术（PLD）联合椎间盘电热疗法（IDET）治疗腰椎间盘突出症的护理经验。方法同顾分析126例DSA引导下PLD联合IDET治疗椎间盘突出症术前、术中和术后的护理方法。结果手术成功112例,无一例发生严重并发症。结论DSA引导下PLD联合IDET治疗椎间盘突出症的科学护理保证了治疗与康复的顺利进行.     

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     

射频热凝靶点消融治疗颈椎间盘突出症疗效观察

目的：观察射频热凝靶点消融治疗颈椎间盘突出症的临床疗效。方法：采用前瞻性自身对照的研究方法,选择颈椎间盘突出症46例,在C形臂X线透视引导下经皮穿刺到椎间隙靶点,采用神经射频仪对靶点进行加热消融,循回治疗3个周期,每周期60s,统计分析治疗前后的视觉模拟评分（VAS）,应用Macnab分级标准评定综合疗效。结果：本组共治疗椎间盘67个。治疗1周后VAS由7.62±0.37下降到2.83±0.65,眩晕症状与功能评分由14.23±2.54上升到26.36±2.68;综合疗效评定总优良率为87.0%,未见明显不良反应。结论：采用射频热凝靶点消融治疗颈椎间盘突出症疗效较好。     

胶原酶溶解术治疗椎间盘突出症与PLD的比较

笔者将PLD(经皮穿刺椎间盘切割术)治疗椎间盘突出症68例与胶原酶溶解术治疗椎闻盘突出症142例的疗效做一比较、评价。操作方法相同，结果表明：两组对照表明：胶原酶溶解术治疗椎间盘突出症疗效优于PLD，该方法操作简单、易行。穿刺针较PLD针细，患者易于接受，可在门诊治疗，易于推广。     

Factors predicting excellent outcome of percutaneous cervical discectomy: analysis of 111 consecutive cases

Percutaneous cervical discectomy (PCD) has been developed as an effective treatment option for soft cervical disc herniation. However, no prognostic study of this procedure has yet been made. The purpose of this study was to evaluate the surgical outcome of PCD and to determine the factors predicting excellent outcome. A retrospective review was performed of 111 consecutive patients who underwent PCD with a mean follow-up period of 49.4 months (range, 29–64 months). Under local anesthesia, a percutaneous anterior approach was followed by discectomy with microforceps and endoscopic Ho:YAG laser. The surgical outcomes of the 111 patients based on the Macnab criteria were excellent in 52 patients (46.9%), good in 37 (33.3%), fair in 9 (8.1%), and poor in 13 (11.7%), thereby indicating a symptomatic improvement in 88.3% of the patients. In this study, the two major factors predicting an excellent long-term outcome were the symptom of radiating arm pain (P=0.02) and the location of lateral disc herniation (P<0.02). Proper patient selection remains critical for the success of this minimally invasive procedure.No funds were provided by any commercial source to support this work.     

经皮颈椎间盘切吸加溶核对颈椎稳定性影响的实验研究

目的：探讨经皮颈椎间盘髓核切吸（ＰＣＤ）加溶核（ＣＮＬ）对山羊颈椎稳定性的影响。方法：健康成年雄性山羊７只、雌性３只,经皮颈椎间盘切吸加溶核手术：Ｃ２－３间盘２只、Ｃ３－４间盘７只、Ｃ４－５间盘１只,术前及术后摄颈椎正位、侧位（中间位、过伸及过屈位）Ｘ线片。颈椎ＭＲＩ检查为颈椎矢状位（中间位、过伸及过屈位）、手术间盘横轴位一随访６～１２个月,平均７．４个月,手术间盘上位椎体下缘与下位椎体下缘的成角     

经皮穿刺椎间盘切割抽吸术治疗颈椎间盘突出症(附101例分析)

目的 探索经皮穿刺颈椎间盘切割抽吸术（ＰＣＤ）的疗效及安全性。方法 对１０１例经临床和ＭＲＩ确诊为椎间盘突出症病人施行ＰＣＤ,观察术后并发症、临床症状缓解程度和突出髓核还纳程度、椎体的稳定性。结果 ＰＣＤ术后６个月及１、２、３、４年优良率分别为８３．２％,８６．１％,８６．０％,８５．７％,６６．７％．３６例合并失稳者随访３个月至１．５年无一例失稳加剧。并发椎间盘炎１例,穿刺点小血肿３例,脊髓一过     

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。     

经皮颈椎间盘切除术治疗颈椎间盘突出症

目的 进一步研究经皮穿刺颈椎间盘切除术（ＰＣＤ）治疗颈椎间盘突出症（ＣＤＰ）疗产的影响因素。方法 回顾分析２１例ＰＣＤ治疗ＣＤＰ患者。观察疗效,论证ＰＣＤ机理,结果 穿刺成功率１００％,２０例优良,无并发症,结论 ＰＣＤ安全且对颈椎稳定性无影响。     

经皮甲状腺外缘入路介入治疗颈椎间盘突出症

日的探讨经甲状腺外侧缘与颈总动脉间入路经皮穿刺切割抽吸术治疗颈椎间盘突出症的1临床效果、不良反应及并发症。资料与方法15例确诊为颈椎间盘突出症患者,全部采用经甲状腺外侧缘与颈总动脉间入路经皮穿刺抽吸治疗。结果手术成功率为100％,11例症状、体征全部消失,3例部分缓解,1例无效。结论甲状腺外侧缘与颈总动脉间入路经皮穿刺切割抽吸术治疗颈椎间盘突出症,出血少,安全性高,值得推广应用。     

颈椎单侧关节突交锁的治疗选择

目的 探讨颈椎单侧关节突交锁的不同治疗方法选择.方法 32例颈椎单侧关节突交锁,行头颅牵引复位成功8例,其中3例维持牵引1个月后改行头颈胸石膏固定,余5例行前路减压植骨融合内固定术.23例牵引失败,其中14例行前路切开复位、椎间盘切除植骨融合内固定术;3例前路复位失败行椎间盘切除加椎体次全切除减压植骨内固定术,1例前路复位失败改行后路切开复位后再前方植骨内固定术;3例行后路切开复位侧块内固定植骨融合术,2例行后路切开复位减压、前路椎间盘切除减压植骨内固定术.1例由于漏诊,伤后8个月行前路减压植骨融合术.结果 平均随访18个月.发现颈椎不稳2例,均为仅行牵引复位,未做融合术者.颈前路手术者植骨块术后12周均获骨性融合.颈椎生理曲度及椎间隙高度恢复较好.无内固定并发症,亦无治疗中神经并发症.结论 下颈椎单侧关节突交锁的治疗需要综合考虑多方面的因素,包括是否伴有椎间盘损伤、是否合并后柱骨折、脊髓压迫及损伤情况.对伴有创伤性颈椎间盘突出的单侧关节突交锁者,前路减压复位稳定术是首选方法,对于不伴椎间盘突出者,可试行牵引复位或直接后路切开复位固定.     

经皮穿刺颈椎间盘切除术对山羊颈椎稳定性影响的实验研究

目的 探讨经皮穿刺颈椎间盘切除（ＰＣＤ）对颈椎稳定性的影响。方法 成年山羊１０只,经皮髓核切除：Ｃ３￣４７只,Ｃ４￣５３只。术前及术后均作颈椎矢、冠、轴位ＭＲＩ及摄正侧位Ｘ线片,并分别测量手术椎间盘的高度及其相邻椎体的成角及位移情况。对以上术前与术后的测量数据,运用统计学检验方法进行ｔ检验。结果 ＰＣＤ术后,７例（７０％）手术部位椎间隙明显变窄;５例（５０％）出现骨质增生,４例（４０％）椎间盘膨出     

Computed tomography-guided percutaneous catheter drainage of primary and secondary iliopsoas abscesses

AIM: To report our experience with computed tomography (CT)-guided percutaneous catheter drainage (PCD) of iliopsoas abscesses. MATERIALS AND METHODS: Twenty-two iliopsoas abscesses in 21 patients (11 women, 10 men) aged between 18 and 66 years (mean 36 years) were treated with PCD. Abdominal CT demonstrated the iliopsoas abscesses, which were definitively determined by Gram staining and aspirate cultures. Twenty of the 22 iliopsoas abscesses were primary and two were secondary. All PCD procedures were performed under local anaesthesia using a single-step trocar technique (n=19) or Seldinger technique (n=3). RESULTS: PCD was an effective treatment in 21 out of the 22 iliopsoas abscesses. Recurrence was seen in three abscesses as minimal residual collections. Two of them resolved spontaneously with anti-tuberculous regimen. One required percutaneous needle aspiration. The procedure failed in a diabetic patient with a secondary abscess, who died due to sepsis. The length of time that catheters remained in place ranged from 21 to 75 days (mean 59.7 days). Complications included catheter dislocation in four abscesses, which required removal of dislocated catheters and indwelling new ones. CONCLUSION: CT-guided PCD is a safe and effective front-line treatment of iliopsoas abscesses. Surgery should be reserved for failure of PCD and presence of contraindications to PCD.     

Transabdominal percutaneous L5 S1 lumbar discectomy: interventional technique, early results, and complications

PURPOSE: Anterior approaches to the lumbosacral spine have become increasingly common in spine surgery, but transabdominal percutaneous lumbar discectomy (TPLD) is challenging. This study describes TPLD and evaluates safety and early clinical results in the management of L5-S1 disc herniation. MATERIALS AND METHODS: Between October 2001 and October 2006, 58 consecutive patients with L5-S1 disc herniations were treated with TPLD of the L5-S1 discs, and nine of the patients with L4-L5 disc herniations were treated with posterolateral percutaneous lumbar discectomy (PPLD) soon after TPLD. The patients were divided into two groups according the operator who performed the procedures. The patients were evaluated with a visual analog scale (VAS) and the Oswestry Disability Index (ODI) at 5 years of follow-up. Logistic regression was used to analyze significant risk factors for complications. RESULTS: Mean hospital stay was 6.38 days +/- 8.48. VAS scores for leg pain and ODI scores showed significant improvement at last follow-up. All patients showed favorable results with no recurrent herniations. Major and minor complications occurred in eight (13.79%) and seven cases (12.06%), respectively, during and after the procedure. Major complications occurred in seven patients treated by operator A and one treated by operator B, a significant difference between operators (P = .044). Multivariate analysis revealed that only bowel preparation remained a significant predictor of complications (P = .040). CONCLUSION: TPLD was a safe and effective procedure for the removal of disc herniations at the L5-S1 level when total bowel preparation was performed.