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1.
目的探讨内镜(METRxTM-tube)下经椎间孔腰椎椎体间融合术的手术方法及近期疗效。方法在内镜METRx辅助下经椎间孔腰椎椎体间融合术治疗退行性腰椎不稳和椎间盘退变合并髓核突出的患者21例。男12例,女9例;年龄35~68岁,平均48.8岁。结果21例患者手术顺利,手术时间平均150min;术中失血量平均120mL;术后平均住院时间8d;无神经损伤,无中转开放手术。术后椎间隙感染1例。21例患者获得随访,时间12~24个月,平均15.7个月。融合率100%。ODI评分术前平均为48.3%,术后3个月平均为16.5%,术后6个月平均为14.0%,优良率97.0%。结论内镜下经椎间孔腰椎椎体间融合术治疗退行性腰椎不稳,手术切口小,创伤小,出血少,术后功能恢复快,临床效果满意。  相似文献   

2.
目的:探索腰椎休门氏病的临床诊断标准及外科治疗方法。方法:9例严重下腰痛患者,X线片显示腰椎1—2个椎间隙狭窄,相邻终板不规则,Schmorl结节形成,所有患者均进行椎间盘造影术,并实施前路植骨或后路椎间融合术。结果:病变椎间隙椎间盘造影试验出现疼痛复制。术后随访6~36个月,平均17个月。6例术后腰痛症状消失,3例腰痛较术前明显缓解。结论:经保守治疗无效的腰椎休门氏病,在精确评估腰椎间盘造影结果的前提下,腰椎融合手术具有较好的临床疗效。  相似文献   

3.
《现代诊断与治疗》2019,(19):3414-3415
目的探讨单节段退变性腰椎滑脱行Wiltse入路微创经椎间孔腰椎椎体间融合术的治疗效果。方法选取收治的单节段退变性腰椎滑脱患者82例,按照手术入路不同分为研究组和参照组各41例。参照组行正中入路微创经椎间孔腰椎椎体间融合术,研究组行Wiltse入路微创经椎间孔腰椎椎体间融合术。术前、术后7d、术后随访12个月以视觉模拟疼痛评分(VAS)评估两组下肢痛、腰痛情况,以日本骨科协会评估治疗(JOA)评估腰椎功能,比较两组手术相关指标(术中出血量、手术时间、下地活动时间、住院时间)、术后随访12个月椎间融合情况。结果与参照组相比,研究组术中出血量较少,手术时间、下地活动时间、住院时间较短(P<0.05);术后7d,研究组JOA评分高于参照组,下肢痛、腰痛VAS评分低于参照组(P<0.05);研究组融合率(92.68%,38/41)与参照组(90.24%,37/41)比较,差异无统计学意义(P>0.05)。结论单节段退变性腰椎滑脱行Wiltse入路微创经椎间孔腰椎椎体间融合术治疗,能减少术中出血量,减轻术后下肢、腰痛,缩短手术时间及术后恢复时间,促进腰椎功能恢复,且椎间融合效果确切,值得推广。  相似文献   

4.
目的:探讨改良的腰椎后路椎间植骨融合术治疗腰椎退行性疾病的临床疗效。方法对76例腰椎退行性疾病患者均采用改良的腰椎后路椎间植骨融合术治疗,并采用视觉模拟评分(VAS)法、日本骨科协会评估治疗分数(JOA)评分法对76例患者术前、术后随访3个月时进行VAS、JOA评分。术后随访1年,行X线检查,同时观察植骨融合率的情况。结果76例患者术后随访3个月VAS得分明显低于术前、JOA得分明显高于术前(P<0.05)。术后随访1年,X线检查示76例患者植骨块无明显移位,无断钉、断棒和松动;植骨融合率为97.4%(74/76)。结论改良的腰椎后路椎间植骨融合术是治疗腰椎退行性疾病的一种有效方法。  相似文献   

5.
背景:椎间融合术已成为治疗腰椎不稳症的有效方法。目地:探讨应用解剖型表面钛涂层椎间融合系统(Pmspace PLIF)治疗腰椎不稳症患者术后椎间活动域的变化。设计:以患者为研究对象,前后对照的观察性研究。单位:一所大学医院的骨外科。对象:2002-12/2003-12采用解剖型表面钛涂层椎间融合器治疗腰椎不稳患者16例,其中男4例,女12例,年龄37—68岁,平均51.6岁。椎间盘突出症4例,椎管狭窄症6例,退变性椎体滑脱3例,椎弓崩裂性滑脱3例,其中Ⅰ度滑脱5例,Ⅱ度滑脱1例。方法:行后路椎间合术,植入两枚融合器,辅以后外侧植骨,不行椎间隙内融合器周围植骨,全部加用了椎弓根螺钉内固定。并对患者术前术后的影像学和临床疗效进行对比。主要观察指标:①测量术前及末次随访的椎间隙及椎间孔高度,椎体间活动域。②功能障碍指数。结果:全部病例均得到随访,随v访时间6-16个月,平均12个月。所有病例均得到融合。术后椎间隙及椎间孔高度均得到满意恢复。Oswestry功能障碍指数评分术前为(44.2&;#177;3.9)分,术后为(25.5&;#177;3.6)分,手术前后比较差异有显著性意义。疗效评定优良率为93.8%。结论:解剖型表面钛涂层椎间融合器应用于腰椎不稳的治疗术后即刻稳性良好。  相似文献   

6.
目的探讨后路椎间盘镜下使用单个可膨胀融合器(B-Twin ESS)固定融合术治疗腰椎退行性疾病的远期临床疗效。方法回顾性分析2007年2月~2010年1月由同一术者完成的21例共22个间隙使用单个B-Twin ESS固定融合术的病例,随访38~64个月,平均50个月,分析术前与术后随访时的JOA评分和椎间隙高度变化,用Suk标准评估椎间隙融合情况。结果 21例患者术前JOA评分为(11.6±2.9)分,末次随访为(26.6±1.5)分,末次随访时的JOA改善率为64.7%~94.4%,平均为86.4%,疗效均达到显效;术前病变椎间隙高度为(9.5±1.5)mm,术后1周为(11.5±1.3)mm,术后6个月为(10.0±1.4)mm,末次随访为(9.4±1.7)mm,术后6个月与末次随访比较差异有显著性(P0.05)。9例(40.9%)达到坚固融合,13例(56.3%)达到可能融合,0例未融合患者。结论经后路椎间盘镜下使用单个B-Twin ESS固定一个椎节治疗腰椎退行性疾病远期症状改善率好,但融合率有待提高。  相似文献   

7.
目的比较经椎旁肌间隙人路单侧椎弓根固定结合改良后路经椎间孔椎间融合(TLIF)术与后正中入路后路腰椎椎间融合(PLIF)术治疗腰椎退变性疾病的疗效。方法腰椎退变性疾病患者38例中18例行经椎旁肌间隙入路单侧椎弓根固定结合改良TLIF术(单侧改良TLIF组),20例行后正中人路后路腰椎椎间融合(PLIF)术(PLIF组),比较两种术式切口长度、手术时间、术中出血量,手术前后JOA评分、腰痛及腿痛VAS评分,末次随访采用改良Macnab标准评估比较两组疗效。结果随访28~35个月,平均33.6个月,末次随访单侧改良TLIF组优良率94.4%;PLIF组85.0%;无融合器移位、下沉及钉棒松动、断裂发生。两组手术切口长度、手术时间、术中出血量比较差异有统计学意义(P〈0.05)。术后JOA评分较术前两组均有明显降低(P〈0.05)。术后1周腰痛VAS评分两组比较差异有统计学意义(V〈0.05),腿痛VAS评分两组比较差异无统计学意义(P〉0.05);末次随访腰痛及腿痛VAS评分两组比较差异无统计学意义(P〉0.05)。结论两种术式治疗腰椎退变性疾病均可达到满意的疗效,比较而言,经椎旁肌间隙入路单侧椎弓根固定结合改良后路经椎间孔椎间融合(TLIF)术有手术切口小、术中出血量少、术后腰背肌疼痛缓解快等优势。临床应用中需严格掌握手术适应症。  相似文献   

8.
脊柱椎间融合术治疗椎间盘突出症合并腰椎不稳   总被引:1,自引:0,他引:1  
刘战立  常山  刘月明  唐曦  张弘 《检验医学与临床》2009,6(17):1437-1438,1441
目的评价椎间脊柱融合术治疗椎间盘突出症合并腰椎不稳的手术疗效。方法对2004年5月至2007年2月,12例腰椎间盘突出症合并腰椎不稳患者行后路椎板开窗、椎间盘摘除、椎弓根螺钉系统固定、单枚Cage植骨的脊柱融合术治疗。术后随访1~3年(平均1.5年),术前和随访时行视觉模拟疼痛评分法(VAS)和疼痛功能指数评分法(Oswestry)评分并进行比较。结果VAS评分术前7.50±2.78,随访时2.04±1.12,比较有显著下降(t=8.23,P〈0.01)。Oswestry评分术前66.8±11.3,随访时下降为26.0±9.8(t=12.54,P〈0.01)。症状改善明显,优9例,良2例,可1例;综合评价标准优良率93.7%。随访时椎间融合11例,未见影像学融合1例,植入物无移位,未发现断钉现象。结论对合并有退变性腰椎不稳的椎间盘突出症采用后路椎间单枚Cage置入加椎弓根螺钉固定的脊柱融合术可以获得良好疗效。  相似文献   

9.
目的比较微创经椎间孔腰椎椎体间融合术与传统后路腰椎椎体间融合术治疗腰椎退变性疾病的临床效果和并发症情况。方法回顾性分析158例腰椎退变性疾病患者的临床资料,其中83例行传统后路腰椎椎体间融合术设为对照组,余75例行微创经椎间孔腰椎椎体间融合术设为观察组;比较两组患者的治疗效果和并发症情况。结果观察组的术中出血量、术后引流量少于对照组(P0.05);观察组术后6月的VAS评分、ODI评分、JOA评分以及椎间融合率、并发症发生率与对照组比较无显著差异(P0.05)。结论微创经椎间孔腰椎椎体间融合术与传统后路腰椎椎体间融合术治疗腰椎退变性疾病的疗效类似,但前者手术损伤更小,出血量与引流量更少,神经损伤发生率更低,具有较高安全性。  相似文献   

10.
背景:经椎板关节突关节螺钉固定、椎问植骨融合治疗脊柱疾患是一种独特的固定方法,可用于退变性腰椎的融合。目的:比较采用微创经腰椎间孔椎体融合联合单侧椎弓根螺钉及经椎板关节突螺钉固定与常规开放后路腰椎体间融合术联合双侧椎弓根螺钉固定治疗下腰痛疾病的临床效果。方法:纳入2010年6月至2012年6月于武警广东总队医院就诊的腰椎间盘突出伴腰椎轻度不稳患者49例,均采用后路减压椎间融合器植骨内固定治疗。其中24例采用微创经椎间孔椎体融合术联合单侧椎弓根螺钉及经椎板关节突螺钉固定,25例采用常规开放后路腰椎体间融合术联合双侧椎弓根螺钉固定,比较两种固定方法的临床疗效。结果与结论:两种固定方法术后椎体融合率、日本矫形外科协会评分及疼痛目测类比评分改善率差异均无显著性意义(P〉0.05)。可见对无严重不稳的单节段退变性腰椎疾病患者,两种治疗方法的效果相当,均能有效提高椎间融合率,使小关节稳定,解除临床症状,门诊随访满意。但采用微创经椎间孔椎体融合术联合单侧椎弓根螺钉及经椎板关节突螺钉固定的患者手术切口长度、手术时间、术中出血量、术后切口引流液量明显减少(P〈0.05),说明该方法具有创伤小、操作简单的优势。  相似文献   

11.
背景:传统的后路腰椎体间融合存在诸多不足,改良经椎间孔腰椎体间融合为需要手术治疗的腰椎退行性疾病提供了新的修复方案。目的:观察脊柱内固定系统置入改良经椎间孔腰椎体间融合对腰椎退行性疾病的修复效果。方法:回顾性分析2010年3月至2013年8月在常熟第二人民医院行脊柱内固定系统置入改良经椎间孔腰椎体间融合的腰椎退行性疾病患者30例,其中退行性腰椎管狭窄症患者6例,Meyerding分型Ⅰ-Ⅱ度;退行性腰椎滑脱患者10例;腰椎间盘突出症伴节段不稳14例。观察患者融合前及融合后末次随访的目测类比评分、腰背痛日本骨科协会评分的改善以及椎间融合情况。结果与结论:30例患者均顺利完成手术并获得12个月以上的随访,所有患者末次随访均无内固定断裂松动,椎间植骨融合良好,无Cage下沉、移位。患者融合后腰背痛症状明显改善,融合前目测类比评分为6.4±0.8,末次随访为1.1±0.6,差异有显著性意义(P〈0.001);末次随访腰背痛日本骨科协会评分26.5±1.2较融合前12.9±1.6明显改善,改善率为(83.9±7.9)%,其中优27例,良3例,优良率100%。提示脊柱内固定系统置入改良经椎间孔腰椎体间融合扩大了适应证,贯彻了传统经椎间孔椎体间融合技术的设计思想和微创理念,操作更加简单、安全,并发症更少,选择性用于腰椎退行性疾病的临床修复效果满意。  相似文献   

12.
Sixty-one randomly selected patients who underwent lumbar fusion surgeries for discogenic low back pain between 1987 and 1994 were retrospectively studied. All patients had failed to respond to preoperative conservative treatments. Forty-two patients received adjunctive therapy with pulsed electromagnetic field (PEMF) stimulation, and 19 patients received no electrical stimulation of any kind. Average follow-up time was 15.6 months postoperatively. Fusion succeeded in 97.6% of the PEMF group and in 52.6% of the unstimulated group (P< .001). The observed agreement between clinical and radiographic outcome was 75%. The use of PEMF stimulation enhances bony bridging in lumbar spinal fusions. Successful fusion underlies a good clinical outcome in patients with discogenic low back pain.  相似文献   

13.
目的:收集行椎间盘造影结合椎间盘内亚甲蓝注射治疗的椎间盘源性腰痛患者的术后及1年后随访资料进行分析,评估该技术的临床治疗效果.方法:2005年8月~2008年11月,我们对67例诊断为椎间盘源性腰痛并经过正规保守治疗3个月无效的患者,采用椎间盘造影结合椎间盘内亚甲蓝注射治疗治疗.通过对患者术后第2天与1年后视觉疼痛评分比例尺和SF-36躯体疼痛调查问卷评分分析,评价椎问盘内亚甲蓝注射治疗对椎间盘源性腰痛的治疗效果.结果:所有67例患者中,术后2天VAS得分较术前平均降低了4.33,SF-36问卷评分平均上升了20.11;术后获得1年随访的47例患者中VAS得分较术前平均降低了4.16,SF-36问卷评分平均上升了17.55.术后2天内及术后1年VAS得分和SF-36问卷评分与术前相比存在显著性差异(P<0.001).治疗及随访期间未发生任何并发症.结论:椎间盘造影结合椎间盘内亚甲蓝注射治疗椎间盘源性腰痛近期疗效比较理想,是一种安全有效的治疗方法.  相似文献   

14.
目的采取回顾分析的研究方法,探讨椎间盘造影术在腰痛融合邻近正常椎间盘的诊断价值。方法53例因椎间盘源性下腰痛行椎间盘切除和后路椎间融合术的患者,手术前行椎间盘造影时,不包括邻近融合节段的正常椎间盘。所有的患者随访35.6个月(24—80个月)。对所有患者的临床疗效和影像学结果进行评价分析。结果53例患者中49例临床效果优良,随访2年以上,38例患者无任何症状。15例患者在渡过21个月的无症状期后出现疼痛复发,采用腰椎MRI和椎间盘造影复查。结果MRI发现15例患者中的8例出现了邻近节段椎间盘的退变,而此8例中仅有1例(2%)经过MRI和椎间盘造影同时证实该节段为疼痛的原因,从而再次进行融合手术。结论术前MRI上表现为正常的相邻椎间盘在椎间融合术后不容易变成病变节段,因此没有必要常规在术前为了排除病变节段而行相邻于拟融合节段的正常椎间盘的造影检查。  相似文献   

15.
This prospective case series study was to determine the outcome of patients with chronic low back pain whose symptoms did not improve with aggressive nonoperative care and who chose intradiscal electrothermal anuloplasty (IDET) as an alternative to chronic pain management or interbody fusion surgery. Sixty‐two patients who had chronic low back pain unresponsive to nonoperative care, no evidence of compressive radiculopathy, and concordant pain reproduction at one or more disc levels on provocative discography were enrolled in the study. Visual analog scale (VAS) pain scores Short Form (SF)‐36 Health Status Questionnaire Physical Function subscale, and SF‐36 Bodily Pain subscale scores were assessed at baseline and at least 1 year later. Mean follow‐up was 16 months, and mean preoperative duration of symptoms was 60 months. Baseline and follow‐up outcome measures demonstrated a mean change in VAS score of 3.0, mean change in SF‐36 physical function of 20, and mean change in SF bodily function of 17. Symptoms improved in 44 (71%) of 62 of the study group on the SF‐36 physical function subscale, in 46 (74%) of 62 on the SF‐36 Bodily Pain subscale, and in 44 (71%) of 62 on the VAS scores. Twelve (19%) of 62 did not show improvement on any scale. Conclude a cohort of patients with chronic unremitting low back pain of discogenic origin whose symptoms had failed to improve with aggressive nonoperative care demonstrated a statistically significant and clinically meaningful improvement on the SF‐36 and the VAS scores at a minimum follow‐up of 1 year after IDET. The positive results should be validated with placebo‐controlled randomized trials and studies that compare IDET with alternative treatments. Comment by Gabor B. Racz, M.D. This is a report on 62 patients from a single practice where the diagnosis of discogenic pain was made. Prior to and at the end of 12‐months, visual analog pain scores and short form (SF‐36 Health Status Questionnaire Physical Function subscale and SF‐36 Bodily Pain subscale scores were assessed. The results indicate a VAS score reduction of 3.0 and a change in SF‐36 physical function of 20 and mean change in SF‐36 bodily pain of 17. Nineteen percent of the 62 patients did not show improvement on any scale. There are significant problems with this study in that there are no controls and no randomization, no reasonable alternatives to heat lesioning the disc was offered as the patient was given the only alternative of interbody fusion surgery. The materials and methods describe the practice as 1,116 patients with chronic low back pain referred to the authors. This must be an unbelievably unique practice as anybody that works with chronic patients would find it almost impossible to have patients with chronic low back pain with no leg pain. It is the rule rather than the exception that patients come to us with back and leg pain. Discogenic pain can give rise to back spasm. The pathways for discogenic stimulation leading to paraspinal spasm have been beautifully outlined by Indahl. Injury to the disc can lead to leaking of disc material causing epidural scar formation involving the sinovertebral system nerves and nerve root or nerve roots. Simultaneously, there may be facet involvement and back spasm originating from the same process. The pathway for discogenic back spasm as suggested by Indahl is likely from the lateral branch of the posterior primary ramus and can also be interrupted by diagnostic nerve block followed by radiofrequency thermocoagulation. The patients in this study supposedly have failed all therapeutic modalities, yet, there is absolutely no mention of caudal lysis of adhesions or transforaminal lysis of adhesions and/or diagnostic and radiofrequency thermocoagulation of the pathways for discogenic back spasm. In our clinical experience, it is extremely rare where patients described in this series would have exclusive solitary disc problem necessitating electro‐thermo‐lesioning of the disc. We certainly find that a great deal of the problem is located in the spinal canal rather than exclusively in the disc or facets. Freeing up the ventral and lateral epidural space by the lysis of adhesions technique, followed by addressing the sino vertebral nerve and facet joint innervation can lead to excellent pain relief for 5 years or longer when the problem is looked at in a nonrandomized, noncontrolled study environment. Furthermore, the pain relief is prompt and does not necessitate the rather elaborate precautions outlined in this paper that clearly are different than the conservative therapy offered to these patients prior to disc lesioning. In the very rare instance, where clearly there is no spinal canal pathology and there is no facet and discogenic back spasm, we do believe an appropriately carried out discogram with monitoring of facial expressions and pressure recordings had resulted in clear rapid response pain relief. I just find a great deal of difficulty in understanding the physiological process of burning the structures within the disc that can take months to lead to pain relief. The rational expectation is that if you thermocoagulate a nerve that is involved in propagating pain, that you should have prompt and lasting pain relief until those nerves or pain pathways regenerate. Clearly, one needs to clarify the issues involved in exposing patients to discitis and osteomyelitis by interventional lesioning with no clear‐cut evidence of reasonable results. The studies need to be carried out with appropriate controls and randomization. Our clinical experience with intradiscal electrothermal treatment comes from two sources. One source is patients who have had the treatment elsewhere and failed to respond and the second source is where we have ruled out any other explanation for the patient's back pain and the patient responds to diagnostic and therapeutic disc procedures, but more commonly without a favorable outcome. These patients then are offered the option of various neuromodulation pain relieving procedures rather than interbody fusion surgery. Richard North has rather convincingly shown documented evidence that spinal cord stimulation gives better outcome than back surgery.  相似文献   

16.
Posterior lumbar interbody fusion: an old concept with new techniques.   总被引:4,自引:0,他引:4  
The estimated cumulative cost of health care attributable to back pain exceeds 25 billion dollars per year in the United States, and more than 200,000 spine fusion procedures are performed each year in an effort to relieve discogenic back pain and instability. These numbers are projected to rise in the face of our aging population. As new interbody grafting sources have been developed, posterior lumbar interbody fusion (PLIF) is being used with increasing frequency. PLIF was once a procedure that required extensive dissection of the musculoligamentous complex of the dorsal spine. Advances in surgical technique and technology now allow access to spinal structures with minimal trauma to surrounding tissue. Knowledge of the various fusion procedures can assist nurses caring for the unique needs of patients undergoing spinal surgery.  相似文献   

17.
目的探讨CT引导下臭氧治疗椎间盘源性腰痛的疗效。方法选取符合椎间盘源性腰痛标准50例患者,在CT引导下对58个椎间盘进行穿刺,在盘内及椎间孔区分别注射浓度为50μg/mL及35μg/mL的臭氧,根据视觉模拟评分及改良的Macnab疗效评定标准进行评定,观察疗效。结果 CT引导下均一次穿刺成功,58个间盘注射臭氧后均诱发或复制出下腰部疼痛,CT表现为纤维环部分撕裂18例,完全撕裂40例,术前及术后3d、3个月、6个月的视觉模拟评分分别为7.53±1.51、4.10±0.43、1.96±0.43、1.71±0.53,术前与术后各个时间段对比,差异具有统计学意义(P〈0.05);术后3d、3个月、6个月的优良率分别为79.8%、89.7%、91.2%。结论 CT引导下盘内外注射臭氧治疗椎间盘源性腰痛操作简单,安全准确,不仅具有影像学诊断价值,而且疗效良好。  相似文献   

18.
背景:腰椎间盘突出症治疗的重要方法是椎间盘切除,但有少部分患者会出现复发现象。 目的:探讨后路椎弓根钉棒内固定联合cage植入椎间融合治疗复发性腰椎间盘突出症后的脊柱稳定性。 方法:选择2007年1月至2011年12月复发性腰椎间盘突出症患者26例,应用后路减压cage植入椎间融合加钉棒系统内固定治疗复发性腰椎间盘突出症进行再手术治疗,观察患者治疗后疼痛症状缓解情况以及腰椎稳定性。通过数据库文献检索的方法分析后路钉棒内固定椎间融合治疗复发性腰椎间盘突出症的椎体稳定性。 结果与结论:26例患者均获得随访,随访时间为12-36个月。所有患者治疗后腰腿痛症状得到有效缓解,椎间融合良好,优良率96.2%。未出现椎弓根螺钉松动、断裂,椎间不融合现象。后路减压cage椎间融合加钉棒系统内固定治疗复发性腰椎间盘突出症,具有症状缓解快、内固定坚强、椎间融合确切等优点,是目前治疗复发性腰椎间盘突出症比较理想的方法。  相似文献   

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