腰椎间盘突出与有无临床症状的影像对照研究

目的：探讨应用区域定位评分法研究腰椎间盘突出（膨出、突出、脱出）有临床症状与无临床症状的相关性及原因分析。方法：将符合要求的CT病理分型为膨出、突出、脱出的体检或住院或门诊患者120例,按有临床症状与无临床症状分为2组,每组按CT病理分型分3组,年龄20-59岁,平均38．5岁,有临床症状与无临床症状两组间在性别、年龄、病程及椎间盘分布节段差异均无统计学意义;应用区域定位评分法对各组评分;用游标卡尺分别测量矢状径指数（SI）、盘黄韧带前间隙、侧隐窝上口宽度、硬膜囊前后径。CT值由X线断层扫描测定,分别测量3次,取平均值。结果：④腰椎间盘突出有临床症状与无临床症状两组在SI、CT值、CT评分、硬膜囊前后径之间差异无统计学意义（P〉0．05）;在侧隐窝上口宽度、盘黄韧带前间隙之间差异有统计学意义（P〈0．05）。②腰椎间盘突出有临床症状与无临床症状两组突出类型比较,差异有统计学意义（P〈0．05）;腰椎间盘脱出有临床症状与无临床症状两组突出节段比较,差异有统计学意义（P〈0．05）。结论：①腰椎间盘突出大小、部位、类型不一定与临床症状存在必然关系,腰椎间盘突出症与压迫程度无正比关系;②椎管内突出髓核是否导致相应的临床症状存在着诸多或必然因素,可能与椎间盘突出物可代偿的椎管储备容量、受累神经根对机械压迫的逃逸避让与弹性延长功能,以及受累神经根低氧消耗与抗缺血性损伤代偿作用等因素有关。     

Subtle huge intervertebral disc herniation

The accuracy of computerized tomography (CT) in diagnosing herniated discs has been well established. Huge herniated discs, which paradoxically may be very subtle, have been mentioned but not stressed as potential causes of false-negative diagnosis. Five cases during a 5-year period encompassing approximately 2500 examinations have been encountered by the authors. In this experience, the most consistent finding is the subtle increased density of the disc compared with the dural sac. The diagnosis is aided by awareness that huge discs severely compressing the dural sac may be very subtle; the use of narrower windows for CT scanning, sagittal re-formation, and occasionally the use of myelography with or without repeat CT scanning may also assist.     

有关腰椎间盘突出症的几点看法

腰椎间盘突出症(lumbar disc herniation,LDH或lumbar intervertebral disc herniation,LIDH))是指由于各种原因(退变、劳损、损伤等)导致腰椎间盘纤维环部分或全部破裂,髓核组织从破裂口向后突起或突出,刺激或压迫腰脊神经根、马尾神经而引起腰腿窜痛或膀胱、直肠功能障碍,即腰痛伴根性坐骨神经痛或二便功能障碍等症状者,也有人称为腰椎间盘纤维环破裂症或髓核脱出症[1]。腰椎间盘突出症是一种比较常     

中央型颈椎间盘突出症

４３例中央型颈椎间盘突出症病例，均累及颈髓引起不同程度的痉挛瘫。本组均无颈部外伤史。６５％的病例颈椎Ｘ线平片无异常所见；６０％的病例仅单间隙突出；７％的病例呈跳跃型多间隙突出；上位颈椎突出约占全部突出间隙的１４％．本组有两种临床类型：亚急性突出和缓慢型突出。游离髓核偶可刺破后纵韧带，突入椎管内甚至硬膜下腔，引起急性严重四肢瘫。缓慢突出型常为多间隙突出，少数合并后纵韧带钙化、骨化。３５例经前路间盘切除、椎间植骨融合；２例行椎管成形术。１例前路减压不彻底、半年后再行单纯椎板切除。平均随访７年月，９７％获得优良疗效，无手术并发症和加重例。     

急性颈椎间盘突出症2例误诊分析

急性颈椎间盘突出症２例误诊分析宋丽华１朱宾２李丹１１内蒙电管局中心医院神经科２放射科０１４０３０内蒙包头市青山区收稿日期：１９９５－１－２６修回日期：１９９５－０３－２０例１，男，５７岁。入院前１ｈ突感头晕，继由１ｍ高处摔下，头部着地，当即昏迷。约３...     

Intradural herniation of a lumbar intervertebral disc

Intradural disc herniation of an intervertebral disc is a rare occurrence. The clinical presentation varies in severity and a high level of suspicion is necessary to determine the diagnosis. This is a case report of an intradural disc herniation in a young male. A review of the literature identifying the pathophysiologic mechanisms of intradural disc herniation, diagnostic imaging techniques, and treatment is presented.     

腰椎间盘突出症的个性化治疗

目的：探讨腰椎间盘突出症个性化治疗的必要性及实用性,分析个性化治疗的临床疗效。方法：503例腰椎间盘突出症患者,根据椎间盘突出物的大小,纤维环是否破裂,椎间盘是否游离、脱垂,是否合并椎管狭窄、腰椎滑脱及是否伴有神经症状等,分别采用个性化的保守治疗、微创治疗、开放性手术治疗。其中393例获得随访,男189例,女204例;年龄23-76岁,平均44．6岁。210例保守治疗,145例微创治疗,38例开放手术治疗。根据Macnab标准对治疗结果进行疗效评定。结果：393例患者平均随访16个月（3个月一3年）。根据Macnab标准：显效346例,有效29例,无效18例,显效率88％（346／393）,有效率95％（375／393）,无严重并发症。保守治疗复发率18．1％（38／210）。微创治疗复发率9．6％（14／145）,开放手术复发率5.3％（2／38）。结论：保守治疗应用普遍,对轻症患者疗效可靠;微创治疗应用越来越广,有主流趋势;开放手术治疗适应证要求严格,传统手术方式受到挑战。个性化治疗适应证的选择是提高疗效的重要途径。     

腰椎间盘突出症治疗方法的选择

腰椎间盘突出症是一种常见病、多发病。根据腰椎间盘突出症不同的病理类型和不同的致痛机制,产生了众多的相应治疗方法,有人形象地将其称为“椎间盘超市”,大体可分为非手术治疗、手术治疗和微创治疗三大类。一个疾病具有如此多的治疗方法,一方面显示了人们的关注程度,     

Traumatic herniation of the thoracic intervertebral disc

Summary A case of spinal compression by herniation of the thoracic disc Th_7–8 is described and the differential diagnosis discussed. The importance of air myelography in the diagnosis of these lesions is stressed. In the surgical treatment a comparatively less radical proceeding is considered advisable.

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Zusammenfassung Beschreibung eines Falles von Rückenmarkskompression infolge Prolaps der Bandscheibe Th_7–8 und Besprechung der Differentialdiagnose.Die Bedeutung der Luftmyelographie bei derartigen Läsionen wird betont. Bezüglich der chirurgischen Behandlung wird ein verhältnismäßig wenig radikales Vorgchen für empfehlenswert gehalten.

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Resumen Descripción de un caso de compresión medular a consecuencia de un prolapso del disco Th_7–8 y comentario sobre el diagnóstico diferencial.Se señala la importancia de la mielografia gaseosa en tales lesiones.Referente al tratamiento quirÚrgico se sostiene como más recomendable un proceder relativamente menos radical.

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Résumé Un cas de compression spinale par hernie du disque intervertébral Th_7–8 est décrit et le diagnostic différentiel discuté. L'intérÊt de la myélographie aérienne dans le diagnostic de ces lésions est signalé. Dans le traitement chirurgical un moins radical procédé paraÎt recommandé.

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Riassunto Viene descritto un caso di compressione midollare da ernia del disco intervertebrale Th_7–8. Ne viene discussa la diagnosi differenziale.Viene sottolineata l'importanza della mielografia gassosa per la diagnosi di queste lesioni. Per quanto riguarda il trattamento chirurgico si giudica consigliabile un atteggiamento meno radicale che per altre localizzazioni dell'ernia del disco.

     

腰椎间盘突出症的经络辨证

从病位与临床表现可见,腰推间盘突出症的证候归属于督脉、足少阳胆经、足太阳膀胱经、足少阴肾经病变,经络辨证分别为属督脉血瘀证、胆经湿热证、膀胱经风寒湿阻证、肾阳亏虚证,临床中可使用经络辨证指导推拿、针灸、内服中药等治疗方法,提高疗效。     

少年腰椎间盘突出症

目的 探讨14岁以下少年腰椎间盘突出症发病机理和临床特征及治疗.方法 8例中,6例正规保守治疗,2例单侧开窗突出髓核及软骨板切除.结果 8例全部经5年以上随访疗效优良.结论 外伤是青少年腰椎间盘突出症的主要病因;症状与体征的不相平行是其临床特点;治疗上主张正规保守治疗,但少数保守治疗3月以上无效、症状体征重者,手术仍是治疗方法 之一.     

Butterfly vertebra with lumbar intervertebral disc herniation

A butterfly vertebra is a rare congenital anomaly that is usually asymptomatic. The authors, however, describe a novel case involving a butterfly vertebra overlapping with disc herniation that presented as radiculopathy. A butterfly vertebra is characterized by a symmetrical fusion defect resulting in a sagittal cleft vertebra. Only a few cases of butterfly vertebrae have been reported as incidental findings. This spinal anomaly may be associated with other congenital conditions such as Pfeiffer, Crouzon, Jarcho-Levin, and Alagille syndromes. Moreover, there is no previous report of a case associated with symptomatic disc herniation from the sagittal cleft. The authors excised the herniated disc fragment. They performed intraoperative discography after exposure of the corresponding intervertebral space via a conventional interlaminar approach. Histological examination of a tissue specimen showed scattered chondrocytes in the myxohyaline stroma, which indicated the nucleus pulposus.     

Diagnostics and treatment of intervertebral disc herniation]

The paper reviews procedures for treatment of intervertebral disc herniation in our Department, evaluating modern scanning methods and surgical procedures. A total of 173 cases aged 13-73 years are presented. Discectomy was performed at surgery, with recent cases also embracing intervertebral spondylodesis with the use of cages to restore intervertebral distance. Short-term follow-up of patients after surgery have been very encouraging.     

钙化型腰椎间盘突出症的手术治疗

目的 探讨钙化型腰椎间盘突出症的临床特点及手术疗效。方法24例钙化型腰椎间盘突出症均行手术治疗。结果随访3～15个月(平均8个月)，优15例，良7例，可2例。结论钙化型腰椎间盘突出症是腰椎间盘突出症的一种特殊类型，一经诊断应尽早手术，疗效满意。     

无症状腰椎间盘突出再认识

腰椎间盘突出症确切致痛机制尚未完全明了，脊神经根的机械性压迫被认为与疼痛和特定节段神经功能障碍有关，然而无症状腰椎间盘突出的现象对此提出不同的解释。该文对近年来有关无症状腰椎间盘突出的机制进行了系统的研究，认为其与椎间盘突出物可代偿的椎管储备容量、受累神经根对机械压迫的逃逸避让与弹性延长功能，以及受累神经根低氧消耗与抗缺血性损伤代偿作用等因素有关。这将深化对下腰痛的理解并有助于相关领域的继续研究。     

腰椎间盘突出症的临床治疗进展

腰椎间盘突出症是因椎间盘退变、破裂、突出,压迫或刺激相邻组织所出现的综合征,系骨科常见疾病,也是患者产生腰腿痛的主要原因之一.     

Immunohistological study of intervertebral disc herniation of lumbar spine

In order to observe histological changes in the extruded and sequestrated intervertebral disc, we conducted pathological and immunological examinations of herniated disc materials taken at the time of discectomy. There were 49 disc materials (from 38 men and 10 women [aged 19 to 78 years; average, 36.6 years]). The herniation was classified into four types, based on the intraoperative observations: protrusion (P), subligamentous extrusion (SE), transligamentous extrusion (TE), and sequestration (S). There were 19 P type discs, 3 SE type, 10 TE type, and 17 S type. The surgical specimens were stained with hematoxylin-eosin, as well as immunohistological staining with the labelled streptavidin biotin method, using human T-cell , human B-cell, and human macrophage antibodies. Inflammatory-cell infiltration was observed at the border of the disc. These findings were present in 19 discs (70%) of the 27 discs of TE and S types (10 TE and 17 S types), but were not seen in the 22 discs of P and SE types (19 P and 3 SE types). Immunohistological staining of the area with inflammatory-cell infiltration revealed the presence of T cells and macrophages, which suggested that this cell infiltration originated from T cells and macrophages, and that the spontaneous resorption of the disc may have resulted from the phagocytic activities of these cells. Received for publication on June 1, 1998; accepted on Nov. 8, 1999