经单孔分体内镜下单侧减压与双侧减压治疗单侧症状腰椎管狭窄症的临床疗效对比

【摘要】 目的：探讨应用单孔分体内镜（one-hole split endoscope，OSE）技术行单侧减压或双侧减压治疗中老年单侧症状中重度腰椎管狭窄症（lumbar spinal stenosis，LSS）患者的早期临床疗效。方法：回顾性分析我科自2021年1月～2021年12月应用OSE技术行单侧减压与双侧减压治疗的中重度腰椎管狭窄症的中老年患者，根据纳入及排除标准，共120例患者纳入本研究，单、双侧减压组（A、B组）分别为60例。统计并比较两组患者住院时间、手术时间、切口长度，术中出血量、手术前后腰椎动力X线片的手术节段活动度（range of motion，ROM）及矢状位平移量（sagittal translation，ST）、入路侧关节面保留率及手术节段椎管横截面积（cross-sectional area of the canal，CAC）。术前及术后7d、3个月、18个月时采用疼痛视觉模拟评分（visual analogue score，VAS）评估腰痛和腿痛程度，采用改良Oswestry功能障碍指数（Oswestry disability index，ODI）评估功能改善情况，末次随访采用改良Macnab评估临床疗效，分析并比较两组手术前后临床疗效评估结果。结果：所有患者均顺利完成手术，A组与B组住院时间比较差异无统计学意义（P>0.05），但B组的手术时间、切口长度及术中出血量均大于A组，差异有统计学意义（P<0.05）。两组术后各时间点的腰痛及腿痛VAS评分、ODI均较术前明显降低（P<0.05），组内术后各指标随时间推移改善显著，两两比较差异均有统计学意义（P<0.05）；两组间术前比较差异无统计学意义（P>0.05），术后7d、3个月、18个月B组腰痛及腿痛VAS评分和ODI均较A组改善更明显（P<0.05）。两组手术节段ST、ROM手术前后比较差异均无统计学意义（P>0.05）。术后关节面保留率B组较A组更高（P＜0.05）。手术节段CAC术前两组间比较差异无统计学意义（P>0.05），但术后B组较A组更大（P<0.05），CAC改善率B组较A组更高（P<0.05）；两组术后CAC较术前均明显增大，差异有统计学意义（P<0.05），术后18个月的优良率A组为86.7%，B组为91.7%，两组间优良例数比较差异无统计学意义（P>0.05）。A组1例术后出现健侧下肢麻木不适症状，B组发生1例轻度硬脊膜撕裂。结论：OSE技术行单侧减压和双侧减压治疗中老年单侧症状的中重度中央管及双侧侧隐窝狭窄LSS安全有效，早期临床疗效确切，其中双侧减压较单侧减压更充分，临床疗效更优，但远期疗效需进一步随访。     

脊柱内镜下可视化半环锯单侧入路双侧减压治疗退行性腰椎管狭窄症的临床效果

目的 探讨脊柱内镜下可视化半环锯单侧入路双侧减压治疗退行性腰椎管狭窄症（DLSS）的临床疗效。方法 回顾性分析2020年1月至2022年6月期间本院诊治的92例DLSS患者的临床资料,其中45例患者行腰椎后路双侧椎板开窗减压术为对照组,47例行脊柱内镜下可视化半环锯单侧入路双侧减压术为研究组,比较两组手术相关指标、疼痛程度和腰椎功能、术后并发症发生情况。结果 两组术中出血量相比,研究组较少;两组住院时间相比,研究组较短（P<0.05）。与术前相比,两组术后1周、1个月、3个月时的VAS评分均显著降低（P<0.05）;研究组术后1周、1个月、3个月时的VAS评分均低于对照组（P<0.05）。与术前相比,两组术后1周、1个月、3个月时的JOA评分均显著升高（P<0.05）;研究组术后1周、1个月、3个月时的JOA评分均高于对照组（P<0.05）。两组并发症发生率相比（4.44%vs. 4.26%）,差异不显著（P>0.05）。结论 脊柱内镜下可视化半环锯单侧入路双侧减压治疗DLSS有创伤小、疼痛轻、术后康复快等优点,有助于促进患者术后腰椎功能恢复,且手术...     

两种不同方法置入Dynesys内固定的早期临床对比研究

目的比较单侧剥离半椎板切除潜行对侧扩大减压联合对侧经多裂肌间隙行Dynesys内固定与双侧剥离全椎板切除Dynesys内固定治疗退行性腰椎椎管狭窄症的早期临床效果和安全性。方法 2010年2月～2011年3月27例退行性腰椎椎狭窄患者（43个节段）行Dynesys内固定手术。15例（24个节段）行症状重侧单侧剥离半椎板切除,潜行对侧扩大减压,对侧经多裂肌间隙安装Dynesys内固定;12例（19个节段）行双侧暴露全椎板切除减压安装Dynesys内固定。通过对患者术前术后疼痛视觉模拟量表（visual analog scale,VAS）评分和腰背、下肢Oswestry功能障碍指数（Oswestry disability index,ODI）,摄正侧位和动力位X线片,记录手术切口,术中术后出血量比较2种方法的临床效果和安全性。结果 27例患者得到8～20个月的随访。2组患者对比研究显示单侧剥离组的手术切口、肌肉创伤、术中出血量、术后引流量及术后初次腰痛评分改善程度优于双侧暴露安装组。影像学资料显示2组患者椎间隙前高、后高及椎间孔高度、面积均较术前明显增加。2组患者椎间隙前高、后高和椎间孔高度、面积改变量及术后节段活动度改变量差别不大。结论单侧剥离半椎板切除潜行对侧扩大减压联合对侧经多裂肌间隙行Dynesys内固定同样可以达到足够的减压效果;与双侧剥离全椎板切除减压Dynesys内固定相比,具有创伤小,术中、术后出血少,术后初次腰部疼痛评分优于后者等优点。     

腰椎后路开窗椎间盘摘除术对继发性腰椎不稳的影响

目的探讨腰椎后路开窗椎间盘摘除术对继发性腰椎不稳的影响。方法回顾性分析2001年至2007年广东省肇庆市端州区华佗医院收治的随访资料完整的242例腰椎间盘突出症患者的临床资料。其中A组（单节段椎间盘突出且为单侧症状者）103例,行单节段后路单侧开窗椎间盘摘除术;B组（单节段椎间盘突出且为双侧症状者）56例,行单节段后路双侧开窗椎间盘摘除术;C组（双节段椎间盘突出且为单侧症状者）47例,行双节段后路单侧开窗椎间盘摘除术;D组（双节段椎间盘突出且为双侧症状者）36例,行后路一节段双侧开窗、另一节段单侧开窗椎间盘摘除术。术后定期复查腰椎侧位过伸过屈站立位X线片,统计4组患者术后继发性腰椎不稳发生率。结果随访时间3～9年（平均5年）。A、B、C、D组患者术后出现腰椎不稳的例数分别为4、8、7、6例,发生率分别为3.9%、14.3%、14.9%、16.7%。4组继发性腰椎不稳发生率比较,差异有统计学意义（P〈0.05）。结论腰椎后路开窗椎间盘摘除术后继发性腰椎不稳的发生可能与手术节段及开窗数有关。     

单侧与双侧后路椎体间融合术治疗腰椎间盘突出伴腰椎不稳的疗效比较

目的比较单侧和双侧后路椎体间融合术(PLIF)治疗腰椎间盘突出伴腰椎不稳的临床疗效。方法手术治疗51例腰椎间盘突出伴腰椎不稳患者,其中行单侧PLIF治疗26例(单侧组),行双侧PLIF治疗25例(双侧组),比较两组的手术时间、术后并发症、临床疗效满意率和植骨融合率。结果手术时间:双侧组(168±20)min,单侧组(94±18)min;术中出血量:双侧组(750±41)ml,单侧组(450±40)ml;术后输血:双侧组7例,单侧组均未输血;以上各项两组比较差异均有统计学意义(P0.05)。术中硬膜囊撕裂:双侧组1例,单侧组无。术后神经根痛加剧:双侧组2例,单侧组1例。患者均获得随访,时间14~30个月。临床疗效优良率:双侧组为84.0%(21/25),单侧组为92.3%(24/26),差异有统计学意义(P0.05)。植骨融合率:双侧组为92.0%,单侧组为96.1%,差异无统计学意义(P0.05)。结论单侧PLIF治疗腰椎间盘突出伴腰椎不稳创伤小,并发症少,临床疗效满意率优于双侧PLIF。     

大通道全内镜下椎间减压融合单侧与双侧椎弓根螺钉内固定治疗腰椎退行性疾病的疗效比较

【摘要】 目的：比较大通道全内镜下椎间减压融合联合单侧椎弓根螺钉固定与双侧椎弓根螺钉固定治疗单节段腰椎退行性疾病的疗效。方法：回顾性分析2019年12月~2021年10月在我院行大通道全内镜下椎间减压融合内固定手术治疗的47例单节段腰椎退行性疾病患者的临床资料，其中20例采用单侧椎弓根螺钉固定（单侧固定组），男5例，女15例，年龄39~69岁（54.1±9.6岁）；27例采用双侧椎弓根螺钉固定（双侧固定组），男9例，女18例，年龄40~70岁（57.8±9.4岁）。两组患者的年龄、体重指数（body mass index，BMI）、性别、手术节段、疾病类型、随访时间等一般资料均无统计学差异（P>0.05）。比较两组患者手术时间、术中透视次数、住院费用、住院时间、手术前后的血红蛋白及变化值和并发症发生率；术前及术后3天、3个月、1年采用疼痛视觉模拟评分（visual analog scale，VAS）评价腰腿痛，术前及术后3个月、1年采用Oswestry功能障碍指数（Oswestry disability index，ODI）评价功能障碍情况；术后1年根据CT评价椎间融合情况，通过改良MacNab标准对临床疗效进行评价。结果：所有患者手术顺利，均获得1年及以上随访，双侧固定组手术时间、术中透视次数、住院费用、住院时间均显著性高于单侧固定组（P<0.05）。两组患者术前、术后血红蛋白值及血红蛋白变化值均无统计学差异（P>0.05）。两组患者术后3天、3个月、1年的VAS评分及术后3个月、1年的ODI均较术前明显下降（P<0.05）；两组同时间点VAS评分及ODI比较均无统计学差异（P>0.05）。两组并发症发生率（单侧固定组10.0% vs 双侧固定组11.1%）、术后1年融合率（单侧固定组90.0% vs 双侧固定组92.6%）及改良MacNab优良率（单侧固定组90.0% vs 双侧固定组88.9%）均无统计学差异（P>0.05）。结论：大通道全内镜下椎间减压融合联合单侧椎弓根螺钉固定与双侧椎弓根螺钉固定治疗单节段腰椎退行性疾病均安全有效，与双侧固定相比，单侧固定术中透视次数、手术时间、住院费用、住院时间更具有优势。     

双侧多节段腰椎板间减压术治疗老年性腰椎管狭窄症

目的　观察双侧多节段腰椎板间减压术治疗老年性腰椎管狭窄症的疗效。方法　对 2 5例老年腰椎管狭窄患者行双侧多节段腰椎板间减压术。结果　随访 1～ 3年 ,2 5例神经源性间歇性跛行均得到缓解 ,7例有反复发作腰痛者 6例明显好转 ,9例下肢神经根性痛全部消失 ,8例皮肤感觉减退者 5例恢复 ,4例拇趾背伸肌力下降者 3例恢复。按照Nakal评分标准 :优 18例 ,良 4例 ,中 2例 ,差 1例。优良率达 2 2 / 2 5。结论　双侧多节段腰椎板间减压术安全简便 ,是治疗老年性腰椎管狭窄症的有效方法。     

经皮侧后路非全内镜下椎间孔内口减压术与全脊柱内镜下椎板开窗减压术治疗腰椎神经根管狭窄症的疗效比较

目的 比较经皮侧后路非全内镜下椎间孔内口减压术与全脊柱内镜下椎板开窗减压术治疗腰椎神经根管狭窄症的临床疗效。方法 回顾性分析自2017-04—2020-11诊治的158例腰椎神经根管狭窄症,79例采用经皮侧后路非全内镜下椎间孔内口减压术治疗（观察组）,79例采用全脊柱内镜下椎板开窗减压术治疗（对照组）,比较两组手术时间、术中出血量、并发症发生率以及术后当天、术后3 d的Cor、NPY、SP水平,比较两组术后3个月ODI指数、Lehmann评分以及临床疗效优良率。结果 两组并发症发生率、住院时间比较差异无统计学意义（P>0.05）。观察组手术时间较对照组短,观察组术中出血量、较对照组少,差异有统计学意义（P<0.05）。术后当天两组Cor、NPY、SP水平比较差异无统计学意义（P>0.05）,术后3 d观察组Cor、NPY、SP水平较对照组低,差异有统计学意义（P<0.05）。术后3个月两组ODI指数、Lehmann评分、临床疗效优良率比较差异无统计学意义（P>0.05）。结论 经皮侧后路非全内镜下椎间孔内口减压术及全脊柱内镜下椎板开窗减压术治疗腰椎神经根管...     

超声骨刀辅助下单侧入路对侧潜行减压治疗退变性重度腰椎管狭窄症的临床疗效

【摘要】 目的：探讨超声骨刀辅助下单侧入路对侧潜行减压治疗退变性重度腰椎管狭窄症的效果和安全性。方法：收集2018年6月～2021年6月超声骨刀辅助下单侧入路对侧潜行减压治疗退变性重度腰椎管狭窄症患者174例[单侧入路双侧减压（对侧潜行减压）经椎间孔腰椎椎间融合术（transforaminal lumbar interbody fusion,TLIF）组,A组],对比同期行双侧经椎间孔减压患者129例（双侧小切口TLIF组,B组）,比较两组之间切口长度、手术时间、术中出血量、术后引流量、住院时间等围手术期参数,行肌酸磷酸激酶（creatine phosphokinase,CPK）检查评估肌肉破坏情况,术后采用疼痛视觉模拟量表（visual analogue scale,VAS）评分以及Oswestry功能障碍指数（Oswestry disability index,ODI）评估术后疗效,并比较两组之间术后并发症和融合情况。结果：两组间比较,两侧切口平均长度和住院时间无明显差异（P＞0.05）,而手术时间、术中出血量及术后引流量A组较B组明显减少,差异有统计学意义（P<0.05）。两组患者术前CPK值差异无显著性意义（P>0.05）,术后1d、3d时B组明显高于A组,差异具有显著性（P<0.05）,术后5d两组比较差异无显著性（P>0.05）。术后3d、1个月、3个月、12个月,两组患者的VAS评分和ODI较术前均显著改善,术后3d、1个月、3个月、12个月时VAS评分和ODI两组均无明显差异（P>0.05）,术后12个月时A组ODI和VAS评分均优于B组,但无统计学意义（P>0.05）。术后出现硬膜撕裂、切口脂肪液化、脑脊液漏、术后感染等并发症两组之间无明显差异。术后出现下肢麻木加重,和臀部/下肢症状反跳的患者比例,单侧入路双侧减压TLIF组均小于双侧小切口TLIF,差异有统计学意义（P<0.05）。术后1年时,单侧入路双侧减压TLIF组有12例尚未融合,双侧小切口TLIF组有8例未融合,两组患者的植骨融合情况差异无统计学意义（P>0.05）。结论：与双侧小切口TLIF手术相比,超声骨刀辅助下单侧入路对侧潜行减压治疗退变性重度腰椎管狭窄症亦可取得较好疗效,具有创伤小,对脊柱稳定性影响小,手术时间短,术中出血少等临床优势,值得临床推广。     

单、双侧钉棒内固定加椎间融合治疗退行性腰椎失稳症的疗效比较

目的探讨单侧钉棒内固定与双侧钉棒内固定配合椎间融合治疗退行性腰椎失稳症的疗效比较。方法将48例退行性腰椎失稳症患者随机分成两组,A组:23例,行单侧钉棒内固定配合椎间融合;B组:25例,行双侧钉棒内固定配合椎间融合,并于术后三个月、六个月、十八个月进行随访,对临床疗效、融合情况、并发症、手术损伤、医疗费用进行总结分析。结果所有手术均顺利完成,A组患者手术时间为60～100min,平均75.5±5.5min,平均出血约150±10ml;B组患者手术时间为100～150min,平均110±11.5min;平均出血约420±9.5ml。随访6～12个月,平均9个月,单侧椎板减压者,两组患者情况基本相似(P0.05),双侧椎板减压者,B组患者情况优于A组(P0.05)。结论对于仅需单侧椎板减压的退行性腰椎失稳症患者,建议行单侧钉棒内固定配合椎间融合,对于需双侧椎板减压的退行性腰椎失稳症患者,建议行双侧钉棒内固定配合椎间融合。     

Trans-sternal bilateral thoracotomy for bilateral lung lesions

The trans-sternal bilateral thoracotomy had been used widely in the early days of cardiac surgery, but since the 1960's the median sternotomy has played a great part in open heart surgery. Recently, the simultaneous bilateral thoracotomy has been used for bilateral lung lesions such as bilateral giant bullae, bilateral pneumothoraces and bilateral metastatic lung tumors. Since 1965 we have performed 6 operations using trans-sternal bilateral thoracotomy for several bilateral lung lesions. The diseases which led to the use of the trans-sternal bilateral thoracotomy technique were 2 cases of bilateral simultaneous pneumothoraces and 4 cases of bilateral lung metastatic tumors. The ages of the patients ranged from 17 to 45 years old. The operative blood loss was between 100 and 810 gm. No case showed postoperative respiratory distress or severe thoracic pain. It would like to be pointed out that the trans-sternal bilateral thoracotomy is the most ideal approach for the multiple bilateral lung metastatic lesions which often invade the chest wall or diaphragm.     

Traumatic bilateral hip dislocation with bilateral sciatic nerve palsy

Bilateral hip dislocation rarely occurs. In this paper, a case of bilateral hip dislocation associated with bilateral sciatic nerve palsy resulted from a road traffic accident is reported. Both hips were emergently reduced under general anaesthesia. Acetabular reconstruction was done bilaterally due to the unstable hips. The patient subsequently developed heterotopic ossification and avascular necrosis on the left hip and underwent total hip arthroplasty. The sciatic nerve on the right side achieved complete recovery but that on the left side only partly recovered and was augmented by tendon transfer. Such injuries are serious and one should be aware of the complications because they can resurface and so patients should be followed up for a long time. To the best of our knowledge, this kind of injury has not been reported in the English .language literature.     

Trans-sternal bilateral thoracotomy for bilateral metastatic lung tumors]

Trans-sternal bilateral thoracotomy has been performed in 4 patients with bilateral metastatic lung tumors. The primary lesion was rectum in one case and the colon in three cases. Two patients were male and 2 were female. Their ages ranged from 63 to 78 years old. An inframammary incision was made with the patient in the supine position, and the chest was entered via the 4th or 5th intercostal space. This procedure provided excellent exposure of the entire mediastinum. Postoperative pain was comparatively severe in the early postoperative period, but was controlled by administering an epidural block. This procedure allows good exposure of the entire thoracic space through a single operative field. We conclude that trans-sternal bilateral thoracotomy is an excellent approach in the patient with bilateral metastatic lung tumors.     

Simultaneous bilateral elbow dislocation with associated bilateral radial head fracture

Bilateral elbow dislocation is a rare injury, with only a small number of case reports in the literature. The majority of these reports describe associated ligamentous injuries only. Simultaneous bilateral radial head fracture in association with bilateral elbow dislocation has only been described on one occasion previously. We present the case of a 54-year-old woman who dislocated both elbows and fractured both radial heads following a fall. In the operating theatre under general anaesthesia, both elbows were reduced by closed manipulation, it was then decided to treat the radial head fractures non-operativley. There was no neurovascular deficit either pre or post reduction. The patient was placed in above elbow casts for 1 week. Both casts were then removed and intensive physiotherapy was prescribed. The patient had an excellent clinical outcome and returned to work as a florist within 6 months of her injury. The purpose of this report was to describe a very rare injury pattern, and to emphasise the importance of early mobilisation following bilateral elbow dislocation.     

Congenital bilateral maxillo-mandibulo zygomatic fusion with bilateral oblique facial clefts

An extremely rare case of bilateral congenital fusion of maxilla, mandible and zygomatic arch with bilateral Tessier type 5 oblique facial clefts and an incomplete cleft of the secondary plate is presented. This is the first report of these anomalies presenting in the same individual. The jaw fusion, facial soft tissue and bony clefts and the cleft palate were managed simultaneously.     

Simultaneous bilateral decortications via video-assisted thoracic surgery for bilateral empyema

IntroductionBilateral empyema is a rare and life-threatening condition that is difficult to treat. We herein report a case of bilateral empyema that was treated with simultaneous bilateral decortications via video-assisted thoracic surgery (VATS).Presentation of caseA 38-year-old female complained of chest pain, dyspnea, and high grade fever lasting two weeks. Computed tomography revealed bilateral notching pleural effusion and pneumonia with atelectasis. Bilateral thoracic drainage was performed. From the right chest, white pus was drained, and Streptococcus anginosus was identified. The left drainage fluid was serous, and no bacteria were identified. We diagnosed the patient with right empyema and left para-pneumonic effusion consequent to pneumonia. Because conservative therapies could not resolve the inflammatory findings, simultaneous bilateral VATS decortications were performed. Both thoracic cavities had loculated pleural effusion. In contrast to the preoperative findings, white pus was found in not only the right, but also the left thoracic cavity. She had an uncomplicated postoperative course and recovered.DiscussionBilateral empyema that has developed to the fibrinopleural phase is difficult to treat with drains alone. Bilateral VATS decortications helped to make a definitive diagnosis and treat both sides simultaneously.ConclusionSimultaneous bilateral VATS decortications should be considered as a feasible and effective procedure for bilateral empyema that is refractory to medical treatment.     

Primary bilateral spermatocele

We report the case of a bilateral, relatively huge, multilocular spermatocele diagnosed at sonography with surgical and pathological correlation. A 45-year-old man presented with bilateral, large inguinoscrotal masses. He had had the masses since his adolescence and their size gradually increased in the past 5 years. Scrotal ultrasonographic examination showed cystic fluid masses that were 65 x 45 x 50 mm in size on the right and 55 x 45 x 40 mm in size on the left side in multilocular spaces. The cystic masses were excised via bilateral inguinoscrotal incision staying near the body of the epididymis. The patient had fathered three children with no fertility problem.