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。     

合并内科病老年腰椎间盘突出症微创开窗手术

目的探讨合并内科病的老年腰椎间盘突出症的手术治疗方法。方法回顾分析2000年1月—2009年3月手术治疗60岁以上且合并内科疾病的老年腰椎间盘突出症56例,手术方法采用小切口椎板间有限开窗髓核摘除,或加侧隐窝扩大术。结果 随访6个月~2年,大部分病人术后恢复理想,优良率达94.3%。结论对于合并内科病的老年腰椎间盘突出症,采用小切口椎板间有限开窗髓核摘除,或加侧隐窝扩大术,手术创伤小,时间短,操作便捷,术后卧床时间短,恢复快,值得临床推广。     

经皮椎间孔镜下髓核摘除术对腰椎间盘突出症患者术后疼痛程度及生活质量的影响

目的 探究经皮椎间孔镜下髓核摘除术对腰椎间盘突出症患者术后疼痛程度及生活质量的影响.方法 选取2013年11月—2016年7月我院收治的77例腰椎间盘突出症患者,依据手术方案不同分组.对照组38例,施行椎板间开窗髓核摘除术;观察组39例,施行经皮椎间孔镜下髓核摘除术.术后随访半年,统计两组手术疗效,并对比手术前后两组疼痛(VAS)、功能障碍(ODI)及生活质量(GQOL-74)变化情况.结果 两组术前VAS、ODI、GQOL-74评分比较差异均无统计学意义(P>0.05);与对照组相比,观察组术后VAS、ODI评分均较低、GQOL-74评分较高,差异有统计学意义(P<0.05);观察组优良率82.05%(32/39)与对照组71.05%(27/38)相比,差异无统计学意义(P>0.05).结论 对腰椎间盘突出症患者予以经皮椎间孔镜下髓核摘除术治疗,可确保手术疗效,同时还可显著缓解术后腰腿疼痛及功能障碍情况,提高生活质量.     

椎板小开窗腰椎间盘摘除术护理配合23例体会

椎板小开窗腰椎间盘摘除术护理配合２３例体会武警山西总队医院骨科李海霞（太原０３０００６）关键词椎间盘摘除术小开窗配合椎板小开窗行腰椎间盘摘除术对机体组织损伤小,术后不破坏脊柱的稳定性是其优点。我院自１９９４年采用该手术方式治疗２３例腰椎间盘突出症患者...     

经椎板间入路椎间孔镜技术治疗腰椎间盘突出症疗效分析

目的 研究经椎板间入路椎间孔镜技术治疗腰椎间盘突出症治疗疗效。方法 选取2017年8月-2018年8月接受治疗的腰椎间盘突出症患者作为研究对象,共计60例,根据不同手术方法分为两组,即对照组、研究组,均为30例。对照组使用经椎间板间隙入路椎间孔镜髓核摘除治疗,剩余30例患者为观察组,治疗措施采用经椎间板入路椎间孔镜技术,评价两组治疗效果,记录两组手术指标,包括术中出血量、手术时间、住院时间以及腰椎间盘功能恢复时间;采用专业的评估量表对两组疼痛程度以及腰椎间盘功能障碍进行评估。结果 观察组治疗总有效率为93.33%,对照组治疗总有效率为66.67%,观察组治疗总有效率较对照组更高,差异有统计学意义(P<0.05);与对照组相比较,观察组术中出血量更少,手术时间、住院时间以及腰椎间盘功能恢复时间更短,差异有统计学意义(P<0.05);观察组与对照组比较,治疗前两组VAS评分及Oswestry功能障碍指数差异无统计学意义(P>0.05),治疗后观察组VAS评分及Oswestry功能障碍指数均明显更低,差异有统计学意义(P<0.05)。结论 对于腰椎间盘突出症患者使用经...     

椎间盘镜和小切口开窗髓核摘除手术疗效比较

目的比较椎间盘镜(MED)与小切口开窗髓核摘除术治疗腰椎间盘突出症的临床疗效,探讨各自的手术适应证。方法200例腰椎间盘突出症患者分为两组,行MED和小切口开窗髓核摘除术各100例。结果按Naka i疗效评价标准,MED组优72例,良21例,可5例,差2例;小切口开窗手术组优70例,良20例,可6例,差4例。两组并发症主要为术后复发MED组2例,小切口开窗组3例;椎间盘炎各1例。无神经根及脊髓损伤。结论两种手术方式疗效均较为肯定,术后疗效大体一致,MED术中出血少,平均住院时间短,但对于多节段椎间盘突出、巨大型、游离型、中央型以及合并椎间盘钙化的手术,小切口开窗疗效较为显著。     

腰椎间盘突出症疗效不佳的临床观察

目的 分析腰椎间盘突出症手术疗效不佳的原因，探讨提高疗效的方法。方法 随访本院1993-2003年腰椎间盘突出症行后路髓核摘除术病例236例，对术后腰腿痛症状未缓解或症状消失后再复发者复查X片、CT或MRI了解病因。结果手术疗效不佳者25例。疗效不佳的主要原因为残留髓核再突出、术后脊柱不稳倾向增加、对侧隐窝狭窄认识不足、神经根损伤、极外侧型椎问盘突出漏切、感染、术后椎管内瘢痕黏连等。全椎板切除术较椎板问开窗术更易发生椎管内瘢痕黏连（P＜0．01）。结论首次手术时应尽可能取净髓核组织，对动力位摄片发现有椎问不稳倾向者行后外侧植骨或椎体问植骨融合，常规探查并妥善处理侧隐窝，牵拉神经根时间不应过长且用力轻柔。行腰椎间盘CT和MRI扫描时，应注意包括椎间盘相邻上下椎体的1／3部，以防止遗漏极外侧型椎问盘突出，尽量采用椎板间开窗术式以减少脊柱创伤，术中间断冲洗，术毕持续负压引流，以减少术后黏连，术中应严格无菌操作。     

后路开窗减压髓核摘除结合Wallis系统固定治疗腰椎间盘突出

目的探析后路开窗减压髓核摘除结合Wallis系统固定治疗腰椎间盘突出症的临床疗效。方法采用随机数字表法将100例腰椎间盘突出症患者分为对照组和实验组,其中对照组使用单纯后路开窗减压髓核摘除术进行治疗,实验组使用后路开窗减压髓核摘除联合Wallis系统固定进行治疗,观察比较两组术中各项手术指标的变化,并随访3个月,观察比较两组腰椎功能恢复情况。结果实验组术中出血量(154±18)ml少于对照组的(285±18)ml,手术时间(72±17)min短于对照组的(134±17)min,两组切口总长度差异无统计学意义(P>0.05)。实验组治疗的总有效率比对照组提高28.00%(P<0.01)。实验组86.00%的患者腰部活动自如,腰腿疼痛症状明显改善,不影响日常活动;对照组只有58.00%的患者腰部活动自如,腰腿疼痛症状明显改善,不影响日常活动。结论应用后路开窗减压髓核摘除结合Wallis系统固定治疗腰椎间盘突出症具有确切的临床疗效,能够有效地促进患者腰椎间盘功能的恢复,缩短治疗时间,患者及家属较为满意,值得在临床上进一步推广应用。     

复发性腰椎间盘突出症的手术疗效与方法选择

目的 探讨复发性腰椎间盘突出症再手术方法的选择,并观察其疗效.方法 对52例腰椎间盘突出症术后复发者进行选择性再手术治疗.其中11例行原椎板间扩大开窗、髓核摘除;13例采用半椎板减压、小关节部分切除加髓核摘除;15例伴有椎节不稳或原先已采用半椎板减压者,行椎间盘切除加椎弓根螺钉固定椎间植骨融合术;13例有双侧下肢症状者,行全椎板减压、椎弓根钉固定、椎间1枚Cage融合器及1枚自体骨块融合.结果 所有患者手术后次日症状明显减轻,术后3周至6个月症状消失,随访5-72个月.JOA评分:再手术前平均10.9分,随访时平均25.8分.X线摄片复查:24例行扩大开窗髓核摘除者未见手术椎节不稳;28例椎弓螺钉内固定者同定椎节融合良好.结论 对于复发性腰椎间盘突出症经保守治疗无效者,再次手术方法选择正确,仍可获得较为理想的效果.     

经皮椎间孔镜腰椎间盘切除术在腰椎间盘突出症治疗中应用

目的探讨经皮椎间孔镜腰椎间盘切除术(PELD)在腰椎间盘突出症治疗中的应用价值。方法回顾性分析自2012年1月至2014年1月解放军180医院收治的90例腰椎间盘突出症患者的临床资料。将所有患者随机分为孔镜组(45例)和开窗组(45例),孔镜组行PELD,开窗组行椎板开窗腰椎间盘切除术。术后随访12个月,比较两组患者手术切口长度、手术时间、术中出血量及住院时间,并用疼痛视觉模拟(VAS)评分和改良Mac Nab标准评价疗效。结果孔镜组的切口长度、术中出血量及住院时间均小于开窗组,差异均有统计学意义(P<0.05)。术后两组患者VAS评分均有所改善,但孔镜组优于开窗组,差异有统计学意义(P<0.05)。两组术后改良Mac Nab标准评价疗效,孔镜组有效率高于开窗组,差异有统计学意义(P<0.05)。结论在腰椎间盘突出症的治疗中,应用PELD能减小手术切口,减少术中出血量,缩短住院时间,提高临床疗效,改善患者生活质量,值得临床推广。     

经皮激光椎间盘减压术治疗颈椎椎间盘突出症

目的 探讨经皮激光椎间盘减压术在治疗颈椎椎间盘突出症的应用.方法 应用SLT30半导体激光治疗仪,在C型臂X线机引导下,选择颈部前外侧经气管、食管与颈动脉鞘之间入路,用穿刺针插入椎间隙中心,然后插入光导纤维,激光输出能量为500～1 000 J.结果 共治疗32例患者,有效率为87.5%,无一例出现感染及其他严重并发症.结论 经皮激光椎间盘减压术具有创伤小、痛苦少、安全性高、恢复快等特点,是治疗颈椎椎间盘突出症的有效方法之一.     

经皮激光气化减压治疗腰椎间盘突出症

目的：激光汽化椎间盘减压(PLDD)治疗腰椎间盘突出症。方法：采用腰3，4或腰4，5椎间盘穿刺，导入激光光纤，利用激光能量，使穿刺部位的髓核化形成空腔。结果：椎间盘内压减低，突出的间盘组织回缩，神经根受压解除，症状消失。结论：PLDD技术，可以确切地说是目前治疗腰椎间盘突出症最先进，最具有微创性，最安全的方法，因此必将受到广大腰腿痛患者的青睐。     

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.     

使用椎间盘镜进行椎间盘髓核切除术的临床体会

随着内窥镜技术的进步,微创手术得到越来越多的临床应用,经椎板间隙显微内窥镜椎间盘切除术(MED)就是微创手术在脊柱外科中的具体应用,它具有手术创伤小、术后恢复快、感染机会少的特点。我们从2000-08开展此类手术以来,共治疗了30例腰椎间盘突出的患者,报告如下。     

Correlation between disc displacements and locations of disc perforation in the temporomandibular joint

Objectives

The aim of this study was to investigate the correlation between disc displacement types and locations of disc perforation in the temporomandibular joint (TMJ).

Methods

157 patients (162 joints) with disc perforation observed through arthroscopy were included in this study. The types of disc displacement were analysed by TMJ MRI before operation. The locations of disc perforation under arthroscopy were recorded. The correlation between types of disc displacement and locations of disc perforation was analysed by Fisher''s exact test.

Results

Medial disc perforation was observed in 55.6% of patients with anterolateral displacement without reduction, but was observed in only 3.7% of patients with pure anterior displacement, and was not observed in patients with anteromedial displacement without reduction. There was a statistically significant difference between these groups in the incidence of medial disc perforation.

Conclusions

There is a correlation between different disc displacements and locations of disc perforation. The incidence of medial disc perforation in patients with anterolateral displacement was significantly higher. The types of disc displacement may have direct influence over the locations of disc perforation.     

Pseudoenhancement of intervertebral disc herniation

Summary Two patients with intervertebral disc herniation appeared to demonstrate abnormally diffuse and intense enhancement of the disc after intravenous administration of gadolinium-DTPA for MRI. Surgery disclosed a dilated epidural venous plexus in one and vascular granulation tissue in the other, associated with the herniated disc material. The mechanism of this pseudoenhancement of the disc appears to be a partial volume effect of disc material and the adjacent veins or granulation tissue. Pseudoenhancement of a herniated disc should be included in the differential diagnosis of a diffusely enhancing epidural mass.     

Juvenile intervertebral disc calcification

Juvenile intervertebral disc calcification is a rare but well described disorder of childhood. The syndrome consists of specific roentgenologic changes: calcification of nucleus pulposus in the intervertebral discs and occasional flattening and anterior wedging of the adjacent vertebral bodies. These changes can be accompanied by clinical symptoms such as neck pain, torticollis, general malaise and slight fever. The etiology and pathogenesis of the syndrome are obscure. The disease usually has a very benign course, the symptoms disappearing in few days and the calcifications in weeks or months. Herniation of the calcified nucleus pulposus has been observed, but even then the disease rarely demands surgery because of the self-limiting course. We present a review of the literature and a case history of a patient with uncommonly persisten roentgenologic changes both in the calcified nucleus pulposus and in the adjacent flattened vertebrae. Correspondence to: L. Rosenkrantz Grage     

Parameter-free optic disc detection

The paper presents a simple, parameter-free method to detect the optic disc in retinal images. It works efficiently for blurred and noisy images with a varying ratio OD/image size. The method works equally well on images with different characteristics which often cause standard methods to fail or require a new round of training. The proposed method has been tested on 214 infant and adult retinal images and has been compared against hand-drawn ground truths generated by experts. It displays consistently high OD detection rates without any prior training or adjustment of the parameters.     

颈椎间盘置换与相邻节段融合的治疗选择

目的 探讨椎间盘置换与相邻节段融合治疗多节段颈椎间盘突出症的临床疗效.方法 对39例多节段颈椎间盘突出症患者,Ⅰ期同时完成病变节段人工椎间盘置换和邻近节段Cage融合.本组39例多节段椎间盘突出症患者,双节段颈椎间盘突出29例,三节段颈椎间盘突出9例,四节段颈椎间盘突出1例.病变节段C3～4、C4～5,2例,C4～5、C5～6 15例,C5～6、C6-79例,C4～5、C6～7 3例,C3～4、C4～5、C5～6 4例,C4～5、C5～6、C6～7 5例,C3～4、C4～5、C5～6、C6～7 1例.临床症状以脊髓压迫为主者18例,以神经根性症状为主者21例,术后随访观察椎间盘假体稳定性、假体活动度、Cage融合状态及Cage位移等.依据日本骨科学会(JOA)评分,Odom标准评定神经功能改善情况,采用颈椎残障功能量表(neck disability index,NDI)评定术后临床症状改善和日常功能状态.结果29例双节段颈椎间盘突出症患者,选择1个节段的椎间盘置换和1个节段Cage植骨融合;9例三节段颈椎间盘突出症患者,7例行1个节段的人工椎间盘置换、2个节段Cage植骨融合;2例选择2个节段的人工椎间盘置换、1个节段Cage植骨融合.1例四节段颈椎间盘突出症患者行2个节段的人工椎间盘置换、2个节段Cage植骨融合.术后随访6个月～3年半,人工椎间盘稳定,椎间盘假体平均活动度为9.3°,Cage全部融合,无Cage松动沉陷.患者神经功能有明显改善,JOA评分由术前9.1分增加至13.2分;NDI评分由术前41.8分降至29.5分;Odom评分临床成功率(优/良/可)达到85%(33例).结论颈椎间盘置换与相邻节段融合为颈椎间盘突出症的治疗提供了新的选择方式,兼顾了颈椎的稳定和运动功能,其远期疗效有待于临床随访.

Abstract：

Objective To evaluate the clinical outcome of artificial cervical disc replacement and cage fusion in the treatment of multi-segmental cervical disc herniation. Methods A total of 39 patients with multi-level cervical disc herniation were treated with disc replacement and adjacent segment cage fusion at one stage. There were 29 patients with two level cervical disc herniation, nine with three level cervical disc herniation and one with four level cervical disc herniation. Of the patients, there were 17 male and 22 female, aged between 35 and 63 years ( mean age 47 years). The herniated disc was located at C3-4 and C4-5 in two patients, C4-5 and C5-6 in 15, C5-6 and C6-7 in nine, C4-5 and C6-7 in three, C3-4,C4-5 and C5-6 in four, C4-5, C5-6 and C6-7 in five and C3-4, C4-8 , C5-6 and C6-7 in one. There were 18 patients with myelopathy and 21 with radieulopathy. The stabilization and the range of motion of implanted disc,the fusion of cage and the displacement of cage were observed on dynamic radiograph postoperatively. The clinical symptom and the neurological function were evaluated according to JOA score and odom' s criteria. Postoperative clinical symptoms and daily function were evaluated by using neck disability index (NDI) scale. Results Twenty-nine patients with bi-level cervical disc herniation underwent single level disc replacement and cage fusion on adjacent segment. Nine patients with three level disc herniation underwent single level disc replacement in seven and level cage fusion on adjacent segment in two. Twopatients underwent two level disc replacement and one level cage fusion. One patient with four level disc herniation was treated with two level disc replacement and two level cage fusion. The patients were followed up for from 6 moths to 3 years, which showed that definite stabilization was achieved for all disc with average range of motion for 9.3 degrees postoperatively. Solid fusion was achieved in all cage, with no subsidence or displacement of cage. The JOA score was increased from 9.1 to 13.2 at final follow up and the NDI (neck disability index) score decreased from 41.8 reduced to 29.5 at final follow up. The clinical success rate (excellent/good/fair) according to Odom' s Criteria was 85%. Conclusion Cervical disc replacement and cage fusion can attain definite stabilization and satisfactory mobility and provide a new effective treatment for cervical disc herniation. The long-term outcome needs further clinical followup.     

颈椎间盘置换与相邻节段融合的治疗选择

目的 探讨椎间盘置换与相邻节段融合治疗多节段颈椎间盘突出症的临床疗效.方法 对39例多节段颈椎间盘突出症患者,Ⅰ期同时完成病变节段人工椎间盘置换和邻近节段Cage融合.本组39例多节段椎间盘突出症患者,双节段颈椎间盘突出29例,三节段颈椎间盘突出9例,四节段颈椎间盘突出1例.病变节段C3～4、C4～5,2例,C4～5、C5～6 15例,C5～6、C6-79例,C4～5、C6～7 3例,C3～4、C4～5、C5～6 4例,C4～5、C5～6、C6～7 5例,C3～4、C4～5、C5～6、C6～7 1例.临床症状以脊髓压迫为主者18例,以神经根性症状为主者21例,术后随访观察椎间盘假体稳定性、假体活动度、Cage融合状态及Cage位移等.依据日本骨科学会(JOA)评分,Odom标准评定神经功能改善情况,采用颈椎残障功能量表(neck disability index,NDI)评定术后临床症状改善和日常功能状态.结果29例双节段颈椎间盘突出症患者,选择1个节段的椎间盘置换和1个节段Cage植骨融合;9例三节段颈椎间盘突出症患者,7例行1个节段的人工椎间盘置换、2个节段Cage植骨融合;2例选择2个节段的人工椎间盘置换、1个节段Cage植骨融合.1例四节段颈椎间盘突出症患者行2个节段的人工椎间盘置换、2个节段Cage植骨融合.术后随访6个月～3年半,人工椎间盘稳定,椎间盘假体平均活动度为9.3°,Cage全部融合,无Cage松动沉陷.患者神经功能有明显改善,JOA评分由术前9.1分增加至13.2分;NDI评分由术前41.8分降至29.5分;Odom评分临床成功率(优/良/可)达到85%(33例).结论颈椎间盘置换与相邻节段融合为颈椎间盘突出症的治疗提供了新的选择方式,兼顾了颈椎的稳定和运动功能,其远期疗效有待于临床随访.