CT引导经腹穿刺腰椎间盘髓核摘除术的临床研究

目的:探讨CT引导经腹穿刺髓核摘除治疗腰椎间盘突出症的应用价值。方法:对75例临床诊断为腰椎间盘突出症,并经CT或MRI检查证实的患者在CT下摘除髓核。用压腹定位器推开肠管,CT扫描明确靶椎间盘及周围各组织结构的解剖位置及相互关系,模拟画出最安全有效的路线,测出与人体各解剖平面的角度,将工作套管置入靶椎间盘中心,逐步施行手术。术后靶椎间盘扫描及患者临床症状和体征复查随访。结果:75例患者均成功摘除髓核组织和/或突出物,临床症状和体征消失或明显改善;3个月至12个月复查68例,症状和体征显效62例(占92％),有效6例(占8％),总有效率为100％;CT检查突出物完全消失58例(占87.9％),明显缩小10例(占12.1％)。结论:CT引导经腹穿刺治疗腰椎间盘突出症,疗效较好,且简便、安全、创伤小。     

经皮腰椎间盘摘除术的临床应用价值

目的探讨经皮腰椎间盘摘除术(PLD)的临床应用价值. 资料与方法选择临床症状典型且经CT或MRI证实的包容性腰椎间盘突出症患者17例,采用经皮穿刺行病变椎间盘髓核抽吸摘除术,并对其疗效进行观察.结果 17例中,12例显效,4例有效,1例无效.全部病例无并发症.结论 PLD是治疗腰椎间盘突出症的一种有效方法,严格掌握适应证是保证疗效的关键.     

侧后路穿刺髓核钳取术治疗腰椎间盘突出症

目的 :探讨经皮穿刺腰椎间盘钳取术治疗椎间盘突出症的疗效和适应症及安全性。方法 :在内镜监视下 ,运用侧后路穿刺 ,髓核钳直接钳取髓核治疗 61例患者。结果 :61例患者术后临床症状及体征均取得满意效果 ,按照所制定的标准评价 ,显效 3 1例 ,优良 2 1例 ,有效 7例。结论 :侧后路穿刺髓核钳取术治疗腰椎间盘突出症是一种理想的微创治疗方法 ,适应证相对较宽。     

经皮穿刺臭氧髓核消融术治疗腰椎间盘突出症112例的护理

目的：探讨臭氧髓核消融术治疗腰椎间盘突出症的护理。方法：112例患者全部成功行CT引导下经皮穿刺臭氧髓核消融术。结果：穿刺成功率为100％。结论：适宜的护理是保证经皮穿刺臭氧髓核消融术治疗腰椎间盘突出症疗效的必要条件。     

经腹穿刺腰椎椎间盘髓核摘除术的临床应用

目的 评价经腹穿刺腰椎椎间盘髓核摘除术(TALD)的疗效和安全性.方法 522例腰椎椎间盘突出症患者采用压腹定位仪腹部施压避开肠管及血管,空心针穿刺椎间盘前缘,逐级套管建立手术通道,经反复钳取髓核组织及负压切吸,实现椎间盘突出部位直接减压.术后随访6～48个月并对随访结果进行统计学分析.结果 522例患者中520例完成TALD,2例因严重肠粘连无法压开肠管而放弃手术,1例术后并发乙状结肠损伤及椎间盘感染.手术穿刺成功率99.4%,无血管及神经损伤等并发症,总有效率93-3%.结论 经腹穿刺腰椎椎间盘髓核摘除术能直接摘除突出部位的椎间盘组织.达到直接减压的效果,手术安全性高,创伤小,疗效好.TALD可作为L5～S1椎间盘突出的常规术式,为L2～L5椎间盘突出的一种补救方式,L1～L2椎间盘不宜行TALD治疗.     

小切口保留黄韧带手术治疗腰椎间盘突出症的研究

目的探讨小切口椎板间开窗保留黄韧带的椎间盘髓核摘除术治疗腰椎间盘突出症的疗效及适应证。方法对183例腰椎间盘突出症患者行小切口椎板间开窗保留黄韧带的腰椎间盘髓核摘除术,剥离浅层黄韧带,保留深层黄韧带。摘除椎间盘髓核后将深层黄韧带恢复到原来的位置。结果 183例随访6个月~3年,优良率达90.2%,术后复查CT或MRI,可见相应黄韧带无变形或塌陷,椎管外瘢痕组织于黄韧带处中止。结论小切口椎板间开窗保留黄韧带的腰椎间盘髓核摘除术能有效地防止术后椎管内瘢痕粘连。     

经皮穿刺腰椎间盘钳取术

目的　探索经皮穿刺腰椎间盘钳夹术治疗椎间盘突出症的疗效和适应证及安全性。方法　对经皮穿刺腰椎间盘的径路作改良和髓核钳结构及摘除髓核操作方法进行改良 ;35 2例椎间盘突(脱 )出症患者共 4 19节椎间盘进行经皮穿刺钳夹术治疗 ,经随访 6～ 38个月 ,对随访结果进行统计分析。结果　术后疗效优 4 5 .5 %、良 4 5 .4 %、差 9.1% ;本组中有 4 4例椎间盘脱出 ,其中 4 0例成功取出脱垂入椎管内髓核并取得优良疗效 ;无椎间盘感染和腰肌血肿并发症 ,马尾损伤 1例经处理后恢复 ,器械断裂 4例。结论　改良式钳夹术安全有效 ,不仅适应于“包容性”椎间盘突出症 ,而且适应于治疗“非包容性”椎间盘脱出症     

CT引导经皮穿刺腰椎间盘髓核摘除术护理

腰椎间盘突出症是临床常见的病症,病人常表现为腰痛、放射性腰痛、腰部活动受限等一系列症状.CT引导经皮穿刺腰椎间盘髓核摘除术可立即解除椎间盘突出压迫神经而致的腰腿痛症状,具有创伤小、见效快、费用低等优点.做好手术前后的护理对手术成功非常关键.我院自2003年2月～12月共收治此类病人35例,通过精心的护理,均收到满意的效果,现将护理体会介绍如下.     

DSA引导下腰骶椎间盘突出经腹前入路椎间盘摘除术16例分析

目的:探讨L5/S1椎间盘突出症经腹前入路椎间盘摘除术(transabdominal percutaneous lumbar discectomy,TPLD)的方法、疗效及优越性.材料与方法:对16例L5-S1腰椎间盘突出症患者行肠道准备后,在数字减影血管造影(digital subtraction angiography,DSA)引导下,经腹前入路行L5-S1椎间盘髓核摘除术.回顾性分析患者病史、治疗过程、临床资料、并发症及随访结果.结果:16例患者治疗后,均住院3～7d,平均4d,出院后随访1～6个月.MacNab腰腿痛手术评价标准评估疗效:显效12例,有效4例,无效0例.术后3个月或6个月共13例行CT或MR复查.突出物影像学变化:明显缩小8例,部分缩小4例,1例无变化.无一例严重并发症发生.结论:L5-S1椎间盘突出腹前入路椎间盘摘除术比侧后路椎间盘摘除术更具优越性,是安全、疗效更可靠的介入治疗方法.     

CT在腰椎间盘突出症化学溶核术适应证选择中的应用

腰椎间盘突出症是腰腿疼最常见的病因之一。治疗方法主要为:牵引,椎间盘切割抽吸,化学溶核术,手术摘除椎间盘或椎板减压术等。突出早期,轻度突出的病人经卧床休息,牵引或药物等保守治疗,症状可缓减或治愈。中重度突出或反复疼痛者往往需要手术治疗,而手术摘除创伤大,病人不易接受。切割抽吸化学溶核术近年来开展比较多,有效率在60%～90%。本文研究引起疗效不佳的病理因素及其CT表现,旨在了解溶核术适应证。1　资料和方法1.1　所选60例均经CT检查确定为腰椎间盘突出症中重度表现者,经非手术治疗无效又不愿接受手术间盘摘除者。其中男51例,…     

Lumbar Chymopapain Chemonucleolysis

Lumbar chemonucleolysis is an alternative treatment of the sciatic pain due to a disc herniation. It gives good results in 70 to 80% of selected patients. When a correct technique is used, the complication rate is lesser than that of the open surgery. The indications of lumbar chemonucleolysis are larger than in the past and include lateral disc herniations, large or migrated disc herniations, and patients under 18 years or over 60 years. Further studies are necessary to determine if magnetic resonance imaging helps in patients selection and improve the success rate of chemonucleolysis.     

Lumbar percutaneous discectomy

Summary Since november 88, 28 patients with lumbar L5 radiculopathy refractory to conservative care and with a radiologically verified central or mediolateral disc herniation at the level of L4/L5 had had a percutaneous discectomy. Radiological verification consisted of spinal CT +/- myelography, +/- myelo-CT, +/- MRI. A shortterm follow-up analysis of at least 2 months taking the clinical and functional status as well as the professional reintegration into account revealed a 64.3% (18/28 patients) satisfactory outcome and a 32.1% (10/28 patients) failure rate. Of the latter 28.6% (8/28 patients) required further open surgery. One patient whose pain had only partially in regressed was shown at open operation to have a sequestered cranial prolapse as revealed by spinal CT after the percutaneous procedure. There were no major complications. One patient developed a sequestered extraforaminal herniation through the nucleotomy canal three weeks after the procedure. One patient bled for 2 minutes. There were no major vessel injuries. One patient reported local muscular pain, and enhanced nerve root pain after introduction of the trocar sleeve.     

Lumbar spinal stenosis

Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal with cord or nerve root impingement resulting in radiculopathy or pseudoclaudication. It is a common diagnosis that is occurring with increased frequency in sports medicine clinics. Symptoms include radicular pain, numbness, tingling, and weakness. Peripheral vascular disease presents similarly and must be considered in the differential diagnosis. Imaging for LSS usually begins with plain radiographs, but often requires additional testing with MRI or CT myelography. There are currently limited controlled data regarding both conservative and surgical treatment of LSS. Most physicians agree that mild disease should be treated conservatively with medications, physical therapy, and epidural steroid injections. Severe disease appears to be best treated surgically; laminectomy continues to be the gold standard treatment.     

Lumbar disc replacement

Lumbar disc replacement is a developing primary surgical treatment for patients with degenerative disc disease. The goals of disc arthroplasty are to remove the native nucleus pulposus and to preserve motion at that disc level. Devices being developed include artificial replacement of the nucleus pulposus and artificial replacement of the entire disc. With the recent approval by the Food and Drug Administration of the Charite artificial disc, this procedure will be used with increasing frequency. This article reviews pertinent anatomy and pathology of the functional spinal unit as well as the types of devices being developed and the factors related to development of a successful implant. Clinical outcomes and complications are also discussed.