微创腰骶骨筋膜切开减压治疗慢性腰痛的临床研究

目的探讨微创方法对腰骶部竖脊肌骨筋膜切开减压治疗因慢性骨筋膜间隔综合征所致的慢性腰痛的临床疗效。方法自2002年2月-2004年1月应用自制针刀、经皮穿刺对腰骶部竖脊肌骨筋膜间隔切开减压治疗因慢性骨筋膜间隔综合征所致的腰痛病人128例,男51例,女77例,年龄19～70岁,平均年龄42.5岁,慢性腰痛时间2～40年,平均15年,局麻下以L3棘突旁2.5cm处为穿刺点,纵行切开骨筋膜11～13cm。术后进行腰、腹肌功能锻炼。对术后腰痛症状、腰部活动度、竖脊肌内压变化及竖脊肌内血流改变与术前比较观察。结果术后腰痛症状较术前明显好转,步行能力明显增加,腰部前屈、后伸活动度较术前分别增加16°±0.5°和8°±0.6°(P<0.05)。术前腰骶部骨筋膜间隔内压在静息、运动中和运动后6min以内分别为(11.2±0.6)、(192±12.23)、(14.2±1.3)mmHg,术后分别为(6.9±0.65)、(163.2±12.4)和(7.2±0.45)mmHg(P<0.05或0.01)。超声多普勒结果表明腰骶部竖脊肌内压最大血流速度和平均血流速度较术前分别增加(0.17±0.02)kHz和(0.19±0.01)kHz(P<0.05)。经3～18个月随访,疗效满意。结论对由慢性骨筋膜间隔综合征所致的腰痛,采用经皮穿刺微创骨筋膜间隔切开减压术治疗是一种简单有效的方法。     

骨筋膜间隔综合征所致慢性腰痛的诊断与治疗

目的探讨由腰骶部骨筋膜间隔综合征所致慢性腰痛的临床诊断、手术治疗方法。方法慢性腰痛患者经临床查体、影像学检查、腰骶部竖脊肌骨筋膜间隔内压测量诊断为慢性骨筋膜间隔综合征者33例,男15例,女18例;年龄18～66岁,平均42.3岁。慢性腰痛时间2～42年,平均27年。采用微创方法行腰骶部竖脊肌骨筋膜间隔切开减压术,术后进行腰、腹肌功能锻炼。结果术后下腰痛症状较术前明显好转,步行能力明显增加,腰部前屈、后伸活动度较术前分别增加15°±0.5°和7°±0.7°(P<0.05)。术前腰骶部骨筋膜间隔内压在静息、运动中和运动后6min以内分别为(10.4±0.9)、(187.1±11.16)和(13.2±1.3)mmHg,术后分别为(6.8±0.8)、(162.3±12.35)和(7.1±0.6)mmHg(t值分别为2.035、2.320、3.211,P<0.05或0.01)。竖脊肌病理改变为退行性变、灶状萎缩和坏死,电镜表现为散在性的骨骼肌纤维排列紊乱,多处骨骼肌纤维变性。超声多普勒结果表明腰骶部骨骼肌内最大血流速度和平均血流速度较术前分别增加(0.17±0.02)kHz和(0.09±0.01)kHz(P<0.05)。结论应用临床检查及骨筋膜间隔内压测定的方法诊断由腰骶部慢性骨筋膜间隔综合征所致的慢性腰痛是可靠的。治疗上可采用骨筋膜间隔切开减压术。     

慢性骨筋膜间隔综合征致下腰痛的临床研究

[目的]探讨慢性骨筋膜间隔综合征所致下腰痛的发病机理。[方法]选取明确诊断为腰骶部慢性骨筋膜间隔综合征且未合并其他腰部疾病的患者30例，分别行腰腹肌肌力测定，竖脊肌内压测定，血常规，血沉，肌酸激酶（CK）及同工酶（CK—MM），乳酸脱氢酶（LDH）及同工酶（LDH，）测定，采用骨筋膜间隔切开减压手术治疗。术中切取竖脊肌标本用于组织病理学观察和透射电镜观察。[结果]各项酶学检验无异常；组织学光镜下观察到竖脊肌纤维部分溶解变性，肌纤维肥大，少量炎性细胞浸润；电镜下观察到肌纤维灶状溶解，核周线粒体聚集，胞内脂滴、溶酶体增多，肌卫星细胞增殖分化。[结论]腰骶部慢性骨筋膜间隔综合征是由于内在压力增加，筋膜间隔内组织代谢障碍，骨骼肌慢性受损，炎症因子释放，最终影响脊神经后支导致的下腰痛。     

小腿骨筋膜室综合征的定位诊断与治疗

目的研究探讨小腿骨筋膜室综合征的定位诊断及治疗效果。方法2000年1月至2005年1月,对240例患者采用改良W h ites ide法测压装置监测小腿骨筋膜室内压。80例患者骨筋膜室内压大于等于30 mmHg(1 mmHg=0.133 kPa),其中前侧骨筋膜室8例,外侧骨筋膜室12例,后浅骨筋膜室16例,后深骨筋膜室28例,涉及2个以上骨筋膜室16例。确认后切开各压力升高的骨筋膜室,前侧和外侧骨筋膜室取小腿前外侧切口,后浅和后深骨筋膜室取胫骨内缘后侧切口,合并胫腓骨骨折者,在切开减压的同时固定骨折,数天后切口二期处理。结果80例患者均获随访5~35个月,平均2年,8例较长时间行走后出现小腿局限性疼痛,偶有放射痛,占10%;4例两点辨别觉及针刺觉减退,占5%;无一例出现肌肉萎缩、爪形趾、缺血性肌挛缩及运动障碍,均能进行正常的工作与生活。结论小腿损伤后,骨筋膜室综合征的发生不容忽视,各骨筋膜室内组织压监测是定位诊断的惟一可靠方法,根据定位诊断有针对性的减压各骨筋膜室,减少了不必要的损伤,可最大限度地恢复小腿的功能。     

血压与骨筋膜室内组织压差值的临床意义

目的探讨测收缩压、舒张压与骨筋膜室内组织压差值的临床意义,旨在为诊疗骨筋膜室综合征提供一个客观标准。方法应用穿刺法通过对30例骨筋膜室综合征血压和骨筋膜室内组织压的测量,明确减压手术的客观指标。结果30例中14例非手术治疗,16例减压治疗,随访均未发生缺血性肌挛缩。结论收缩压、舒张压、骨筋膜室内组织压的结合测量,对指导骨筋膜室综合征何时行减压术有重要的临床意义。     

跟骨骨折合并肌筋膜间室综合征的诊断与治疗

目的探讨跟骨骨折合并足部肌筋膜间室综合征的诊断及治疗方法。10月～1999年6月,利用Whiteside法测压装置对98例跟骨骨折患者进行足部肌筋膜间室内压力监测。其中9例间室内平均压力达46mmHg30～55mmHg),均经足后内侧入路进行足部肌筋膜间室切开减压术。术后继续监测全足各筋膜间室内压力,1例足部严重碾压伤者,术后跖骨间肌筋膜间室内压力仍为40mmHg,故再次行前足背侧入路减压。9例患者术后1周以刃厚皮片覆盖伤口口愈合经外侧入路行跟骨骨折切开复位内固定术。结果9例患者平均随访2年行走或站立过久时足跟及踝部有轻度疼痛,其中1例两点辨别觉、痛觉略有减退。无一例出现前足僵硬、爪形趾、软组织萎缩及运动功能异常。结论肌筋膜间室压力测定是诊断跟骨骨折合并足部肌筋膜间室综合征惟一可靠的方法,治疗方案以足后内侧切口进行减压疗效较好。     

改良手术减压结合药物治疗足骨筋膜室综合征15例

足部骨筋膜室综合征与其他部位的骨筋膜室综合征一样,都是由于骨筋膜室内的压力增高导致肌肉与神经发生进行性缺血坏死的病理状态.足部的骨筋膜室小,骨折损伤处的严重出血导致骨筋膜室内的组织压进行性增高,进而微循环破坏而产生严重后果.治疗应当以迅速减压为第一要务.笔者自2006年6月～2011年12月采用改良手术减压加药物综合治疗足部骨筋膜室综合征15例,均取得满意疗效,报告如下.     

胫骨平台骨折并发骨筋膜室综合征的临床治疗

目的探讨胫骨平台骨折合并小腿骨筋膜室综合征的发生机理与临床治疗策略。方法本组胫骨平台骨折病人108例，其中13例并发骨筋膜室综合征，男11例，女2例，年龄15～67岁，平均37岁，进行小腿筋膜室切开减压加腘窝筋膜切开和骨折固定治疗。结果7例先行小腿筋膜室减压，胫骨平台骨折未作处理，术后发现小腿肿胀减退不明显，肌肉外翻张力仍高，分别在术后8～24h内进行二次手术腘窝筋膜切开减压，腘动脉探查，骨折固定。1例小腿缺血改变严重，坏死并行股骨髁上截肢，1例小腿肌肉坏死，3例足部皮肤溃烂，2例无并发症发生，肢体均成活。5例小腿筋膜室减压同时行腘窝筋膜切开减压和骨折固定治疗，预后良好，功能正常。1例拒绝手术治疗导致截肢。结论胫骨平台骨折并发骨筋膜室综合征，早期行小腿骨筋膜室切开减压加腘窝筋膜切开减压和骨折固定治疗，在减压的同时应松解膪窝部的动静脉压迫，从根本上解决骨筋膜室综合征形成的一个因素，获得满意疗效，减少伤残率。     

四联疗法治疗小腿骨筋膜室综合征切开减压术后感染1例

<正>筋膜广泛切开减压是治疗骨筋膜室综合征的常用手术方式,但是术后肌肉外露甚至骨外露容易引起感染。笔者于2020-08诊治1例小腿骨筋膜室综合征切开减压术后合并感染,采用封闭负压引流、置入抗生素骨水泥珠链、皮肤牵张、支持治疗,取得了良好的疗效,报道如下。     

退变性脊柱侧凸的选择性手术治疗

【摘要】 目的 评价选择性手术治疗退变性脊柱侧凸的临床疗效。 方法 2005年1月~2009年9月共手术治疗22例患者。记录所有患者术前、术后3个月及末次随访时的Oswestry功能评分;记录实施内固定治疗患者术前、术后3个月及末次随访时的侧凸Cobb角、腰椎前凸角以及融合时间。 结果 平均随访19个月（8~36个月）。椎管减压3例;椎管减压并内固定植骨融合术19例,其中长节段固定6例。Oswestry功能评分术前为39.25±10.47,术后3个月为13.85±7.73,末次随访时为17.95±6.18。实施内固定的患者侧凸Cobb角术前为21.05°±8.51°,术后3个月为12.13°±4.83°,末次随访时为14.03°±5.25°;腰椎前凸角术前为 14.40°±14.72°,术后3个月为26.62°±11.48°,末次随访时为24.27°±11.03°;术后6个月,均达到骨性融合。上述各组术后3个月及末次随访的数据与术前比较差异均有统计学意义（P＜0.05）。 结论 退变性脊柱侧凸的治疗主要以缓解症状为目的,依据不同的临床及影像学表现制定个体化治定方案能够取得满意的临床疗效。     

Exercise pain in the lower leg. Chronic compartment syndrome and medial tibial syndrome

The aetiology of pain in the lower leg during exercise has been studied in 110 athletes by monitoring intracompartmental pressure during exercise and by technetium bone scans. Patients were assigned to three diagnostic groups: chronic compartment syndrome, medial tibial syndrome and those with non-specific findings. Our results indicate that subcutaneous fasciotomy of the affected compartment(s) is the treatment of choice for chronic compartment syndrome. The treatment of patients with medial tibial syndrome, either by operation or conservatively, has been unsuccessful; non-specific symptoms have been treated conservatively with success.     

Lumbar paraspinal compartment syndrome

The purpose of this study was to systematically review the available evidence on lumbar paraspinal compartment syndrome with specific reference to patient demographics, aetiology, types, diagnosis, clinical features, and treatment. This was an Institutional Review Board-exempt study performed at a Level 1 trauma center. A PubMed search was conducted with the title query: lumbar paraspinal compartment syndrome. Eleven articles met our search criteria. Three of the patients with acute paraspinal compartmental syndrome treated with fasciotomy had a full recovery and were able to resume skiing after four months. The aetiology of the onset of lumbar paraspinal compartment syndrome is broadly divided into acute and chronic. Lumbar paraspinal compartment syndrome is one of the causes of back pain with diagnostic clinical features which should be considered in the differential diagnosis of a patient with low back pain. Prospective multicentre trials may provide the surgeon with more insight into the diagnosis and management of lumbar paraspinal compartment syndrome.     

Chronic scrotal pain syndrome: management among urologists in Switzerland

INTRODUCTION AND OBJECTIVES: Management of patients presenting with chronic or recurrent pain located in the scrotum is often very challenging. Evidence-based literature and clinical practice guidelines for the management of chronic scrotal pain syndrome (CSPS) are not available. We assessed the current perception and management of chronic scrotal pain syndrome by urologists in Switzerland. METHODS: In July 2004, all the members of the Swiss Society of Urology received a questionnaire focusing on diagnostic and treatment practices for the management of chronic scrotal pain syndrome. The questionnaire consisted of 6 topics concerning practice setting, incidence, aetiology, diagnostics, therapy and treatment success rate. RESULTS: 103 questionnaires were completed (63%). All but 2 (2%) responding Swiss urologists see a mean of 6.5 new patients per month (range 1-30). 79% of Swiss urologists consider CSPS to be infectious or post-infectious in nature. Furthermore, a history of vasectomy, psychosomatic disorders, chronic prostatitis, neuromuscular disorders, a history of inguinal surgery, and idiopathic aetiology were mentioned in decreasing order. The most commonly used examinations are urinalysis in 96% and ultrasound in 93%. Additional assessments include blood sampling, duplex ultrasound, assessment for coexisting chronic prostatitis, and referral to an Orthopaedist, Rheumatologist or Psychiatrist. The predominant medication prescribed for CSPS is a non-steroidal anti-inflammatory agent given for a mean of 15.5 days. An antibiotic trial is prescribed by 82% for a mean of 20.5 days. 74% consider epididymectomy the treatment option of choice in recurrence. Inguinal orchiectomy is performed by 7%, microsurgical spermatic cord denervation is performed by 6% of surgeons. Mean estimated recurrence rate after conservative treatment is 48% and thus higher than after epididymectomy with 18%. CONCLUSIONS: Chronic pain located in the scrotum is a common clinical condition in Switzerland. Most urologists consider an infection or post-infectious alterations as the predominant aetiology for CSPS. Consequently, an antibiotic trial in combination with an anti-inflammatory agent is prescribed as first-line therapy. Recurrence rates for conservative treatment are estimated high which is in contradiction to the presumed aetiology. Therefore, further evaluation of this poorly described disease complex is required.     

Chronic spinal arachnoiditis. A postoperative syndrome that may signal its onset

Chronic lumbar radiculopathy following spinal surgery is reported, in which 7 of 25 patients reviewed developed a postoperative syndrome immediately after their original surgery. Later, sometimes years later, all 7 patients developed severe chronic spinal arachnoiditis. This syndrome was characterized by transient violent spasms in the legs, muscle cramps, increased radicular pain, and often fever and chills. The recognition of this syndrome and a proposed method of treatment is discussed.     

Chronic exertional compartment syndrome with medial tibial stress syndrome in twins

Chronic exertional compartment syndrome and medial tibial stress syndrome are uncommon conditions that affect long-distance runners or players involved in team sports that require extensive running. We report 2 cases of bilateral chronic exertional compartment syndrome, with medial tibial stress syndrome in identical twins diagnosed with the use of a Kodiag monitor (B. Braun Medical, Sheffield, United Kingdom) fulfilling the modified diagnostic criteria for chronic exertional compartment syndrome as described by Pedowitz et al, which includes: (1) pre-exercise compartment pressure level >15 mm Hg; (2) 1 minute post-exercise pressure >30 mm Hg; and (3) 5 minutes post-exercise pressure >20 mm Hg in the presence of clinical features. Both patients were treated with bilateral anterior fasciotomies through minimal incision and deep posterior fasciotomies with tibial periosteal stripping performed through longer anteromedial incisions under direct vision followed by intensive physiotherapy resulting in complete symptomatic recovery. The etiology of chronic exertional compartment syndrome is not fully understood, but it is postulated abnormal increases in intramuscular pressure during exercise impair local perfusion, causing ischemic muscle pain. No familial predisposition has been reported to date. However, some authors have found that no significant difference exists in the relative perfusion, in patients, diagnosed with chronic exertional compartment syndrome. Magnetic resonance images of affected compartments have indicated that the pain is not due to ischemia, but rather from a disproportionate oxygen supply versus demand. We believe this is the first report of chronic exertional compartment syndrome with medial tibial stress syndrome in twins, raising the question of whether there is a genetic predisposition to the causation of these conditions.     

Chronic venous compartment syndrome]

Various forms of compartment syndrome can now be distinguished. Acute compartment syndrome is the result of a discrepancy between the volume of the compartment and its contents. This leads to increased pressure at rest and during load, which cuts off the micro-circulation and hence destroys the intracompartmental structures. Chronic compartment syndrome had only been seen in athletes and soldiers up to now. The disease mainly affects the anterior compartment and the fibular muscle group, and only rarely the lateral muscle compartment. In the course of severe venous diseases, a chronic venous compartment syndrome develops which is fundamentally different from the clinical pictures previously known. The cicatricial destruction of the crural fascia exerts an effect on the intracompartmental pressure with every step the patient takes. In severe cases, this results in considerable changes in the muscles involving chronic ischaemia associated with necrosis and glycogen deficiency. Further investigations are necessary in order to define the clinical picture, particularly by measuring the intracompartmental pressure under dynamic and standardised conditions. We suggest also making a verbal distinction between the two forms: a chronic exertional compartmental syndrome and a chronic venous compartmental syndrome.     

Gluteal compartment syndrome after intramuscular gluteal injection

Complications after i.m. injection are rare. Only few cases need emergency operative treatment. This case report shows the exclusive situation of a gluteal compartment syndrome caused by a hematoma. Clinical findings showed signs of nerve compression with sciatic pain. Only immediate surgical treatment prevented persistent nerve or muscle tissue damage.     

慢性前列腺炎综合征病人NIH-CPSI问卷分析

目的 :探讨NIH CPSI对慢性前列腺炎综合征的临床价值。　方法 :应用NIH CPSI问卷 ,随机对 2 2 7例慢性前列腺炎综合征 (CPS) /慢性盆腔疼痛综合征 (CPPS ,包括ⅢA和ⅢB)和 32例良性前列腺增生 (BPH)进行观察。结果 :①CPS病人的主要症状表现为疼痛或不适 ,明显多于BPH病人 ;② 79.30 %CPS病人有排尿不尽 ,而排尿后 2h以内又有尿意为 4 4 .93% ;③ 5 1.5 1%CPS病人因慢性前列腺炎症状影响工作 ,90 .31%的病人影响业余生活 ,6 8.72 %的病人影响生活质量 ,与BPH病人比较 ,明显影响CPS病人的生活质量。　结论 :应用NIH CPSI问卷观察CPS ,表明CPS病人的主要症状是疼痛或不适 ,且对工作与生活质量有明显的影响     

无张力疝修补术后慢性疼痛的原因分析及防治

目的 探讨无张力疝修补术后慢性疼痛的原因及防治方法.方法 对142例实施无张力疝修补术患者的临床资料进行回顾性地分析.结果 均行无张力疝修补术,按补片类型分为2组:聚丙烯类组(n=70)和聚四氟乙烯组(n=72).术后疼痛发生率:聚丙烯类组为10.0%(7/70),聚四氟乙烯组为4.2%(3/72),2者差异有统计学意...