手法加牵引治疗腰椎间盘突出症

手法加牵引治疗腰椎间盘突出症张国强理疗科主题词正骨手法，中医伤科学，牵引术，椎间盘移位腰椎间盘突出症是腰椎间盘的变性、破坏、髓核从损伤的纤维环处膨出的一种腰椎间盘病变。其突出的部分和变性的纤维环引起脊髓马尾、腰神经根的压迫刺激症状，或因髓核的变性，软...     

中药熥敷联合应用川芎嗪改善腰椎间盘突出临床症状的护理体会

腰椎间盘突出症临床伴有明显腰段神经根刺激症状的患者,在临床症状缓解后CT复查发现大部分患者突出髓核形态并未有变化。因此,有学者认为突出髓核组织并非是刺激诱发根性刺激体征的直接因素，而是继发压迫或刺激了椎管或椎间孔内的动静脉丛，由此引起的软组织水肿压迫或刺激了神经根而产生了根性刺激症状，手法治疗使局部血运加强，     

腰椎间盘退行性病变的影像学评价

本综述了腰椎间盘退行病变的发病机制、病理解剖及其影像学诊断的新动态。腰椎间盘突出的主要病理基础为髓核成份改变和纤维环内裂隙。腰椎间盘突出在ＭＲＩ上的分型，即①椎间盘膨隆。②椎间盘突出。③椎间盘疝。④椎间盘游离。给临床医生制定合适的治疗方案提供了客观依据。ＭＲ成像和增强ＣＴ扫描区别椎间盘术后复发和术后疤痕形成的价值相似，但增强ＭＲ成像具有更高的敏感度。     

突出髓核组织与腰椎间盘突出症的发病

自1934年Mixter和Barr用手术方法证实突出髓核组织与坐骨神经痛的关系以来,突出髓核组织的局部激刺作用一直被认为是腰椎间盘突出症(以下简称腰突症)的发病关键。近年来由于临床研究的不断发展,这种观点也开始引起一些争议。现将这方面的情况概要地做一总结。     

倒悬牵引旋扳法治疗腰椎间盘突出症CT研究

腰椎间盘突出症是临床常见病，是导致腰腿痛的主要病症之一。牵引推拿临床疗效显著，但其机制尚不十分明确，临床治疗存在盲目性。本研究旨在运用影像学方法，从腰椎间盘突出髓核面积、突出椎间盘椎间隙高度、突出椎间盘相邻椎体夹角、腰椎生理曲度值及腰椎小关节对称性角度探讨倒悬旋扳法治疗腰椎间盘突出症的机制，为临床治疗提供理论依据。     

脊髓造影诊断腰椎间盘突出症的临床价值

椎间盘髓核突出症是农村常见的腰腿痛病症之一，在就诊中做一般的体格检查及摄取平片也难以准确诊断。有条件的医院均采用CT或MRI可解决诊断问题，但我国大部分地区经济还处于贫困阶段，绝大部分乡镇医院还没有先进的医疗设备。我院在购进CT之前，曾对13例症状较重且典型的患者做脊髓造影，提供了临床手术可靠的依据。其中经手术8例，均证实脊髓造影对诊断腰椎间盘髓核突出症的重要性。     

腰椎间盘突出症中医证型与CT探讨

腰椎间盘突出症是髓核经纤维环向周围组织突出，伴有髓核和纤维环的变性，由于外伤和劳损使纤维环破裂，髓核突出刺激或压迫神经或硬膜囊，引起腰痛和下肢放射性疼痛为特征的一种常见病症。中医则为外感六淫、跌仆损伤或肝。肾亏损而致气血瘀滞、经脉闭塞不通或筋脉失养而发。     

经皮腰椎间盘切割术的疗效与相关因素分析

目的：通过对169例经皮腰椎间盘切割术（PLD））的病例随访资料分析，总结影响疗效的相关因素。材料和方法：本文对随访资料进行统计学分析，找出各种因素与疗效的相关性。结果：PLD术后总有效率87％，疗效与年龄、椎间盘突出类型、突出指数、髓核切出量及髓核有否变性无明显相关性，与病程有一定的相关性。结论：PLD术后的病人其年龄、椎间盘突出类型、突出指数、髓核切出量及有否变性对疗效影响不大，急性期、有严重外伤史的病例不宜在近期内做PLD治疗。     

游离型腰椎间盘突出的MRI表现

目的:研究游离型腰椎间盘突出在MRI中的表现及诊断价值。资料与方法:回顾性分析24例经手术病理证实的游离型腰椎间盘突出患者的MRI表现。结果:24例游离髓核中，23例位于椎管内硬膜外，其中15例见于椎弓根内侧缘，5例位于椎间孔处，3例位于黄韧带区；仅1例位于髓外硬膜下。24例均为单发病灶，呈卵圆形、圆形或不规则形；游离髓核于T1WI上呈等或低信号，T2WI上呈等或高信号，当有钙化时，呈低信号灶。其中10例作了增强扫描，病灶中心部分均无强化表现，有4例呈边缘强化。结论:MRI对游离髓核能作出正确的诊断，是首选的检查方法。     

腰椎间盘突出症手术与非手术治疗的长期随访研究

目的　对随访 10年以上的腰椎间盘突出症病人进行回顾性研究 ,评价不同治疗方法的效果 ,为临床提供参考。方法　筛选 10年以前在解放军总医院住院或门诊治疗的腰椎间盘突出症病人作为研究对象 ,随访年限为 10～ 38年 ,平均 2 6年。根据治疗方法分为非手术治疗、单纯髓核摘除、髓核摘除椎间植骨融合 3组。观察 10年以上的远期疗效、影像学改变 ,测量突出间隙在治疗前与 10年后的高度值并进行统计学分析 ;记录相邻椎间隙退变情况。结果　非手术治疗组共 98例 ,85例可正常生活和工作 ,13例因间歇性跛行而行椎管减压手术 ,病变间隙高度平均减低 3 17± 1 6 5mm ,13例出现相邻椎间隙轻度退变。髓核摘除组 84例 ,71例可正常生活和工作 ,13例病人因复发行再次椎间盘手术 ,病变间隙高度平均减低 5 5 0± 1 5 1mm ,15例病人出现邻近间隙的退行性变。髓核摘除融合组 71例 ,均可正常生活和工作 ,突出间隙骨性融合 ,39例出现邻近间隙的退变 ,但无症状。结论　如适应证得当 ,非手术治疗和手术治疗的长期随访结果相似 ;非手术治疗可作为椎间盘突出症的首选疗法 ,行单纯髓核摘除时应尽量保留相对正常的髓核组织 ,椎间融合术是较好的手术方法。     

臭氧盘内注射术联合胶原酶盘外溶解术治疗突出型腰椎间盘突出症的多中心应用观察

目的探讨经皮穿刺臭氧盘内注射联合胶原酶盘外溶解术,治疗腰椎间盘突出症的疗效及安全性。方法按统一的选择标准[纤维环破裂、髓核突出幅度在10mm以内、压迫硬膜囊或(和)神经根的腰椎间盘突出症]、治疗方法(臭氧盘内注射联合胶原酶盘外溶解),对行臭氧盘内注射术加联合胶原酶盘外溶解术、资料完整的腰椎间盘突出症541例患者进行复诊、书信、电话等方式随访观察,随访时间和例数分别为:2～3个月(近期)541例,4～12个月(中期)312例,13～18个月(远期)115例,按统一的疗效标准评价臭氧盘内注射联合胶原酶盘外溶解术的近、中、远期疗效,并与有关多中心单纯行胶原酶盘外溶解术例疗效进行对比。结果所选病例近、中、远期有效率分别为95.9%(519/541)、90.4%(489/541)、87.2%(472/541);两种方法联合应用,突出的髓核有明显的不同程度的回缩,平均缩小30.5%;单纯行胶原酶溶解术近、中、远期有效率分别为89.5%、82.4%、80.4%。结论臭氧盘内注射联合胶原酶盘外溶解术是纤维环破裂、髓核突出幅度在10mm以内、压迫硬膜囊或(和)神经根的腰椎间盘突出症的一种高效的治疗方法,其疗效优于单纯胶原酶溶解...     

Progressive and regressive changes in the nucleus pulposus. Part II. The adult

The spines of 28 cadavers were studied with magnetic resonance (MR) imaging, correlated with anatomic sections, to characterize the progressive and regressive changes in the nucleus pulposus. Four additional types of nucleus pulposus were identified in this study. The transitional type (type II) of childhood had fibrous tissue that developed near the anulus fibrosus anteriorly or posteriorly. MR images showed a notch of reduced signal intensity in the nucleus pulposus where the fiber was developing. The adult type (type III), which is predominant after age 30 years, had an indistinct boundary between the nucleus pulposus and anulus fibrosus. MR images showed the fibrocartilage in the nucleus pulposus and inner anulus fibrosus as areas of high signal intensity. Adult disks with a tear of the anulus fibrosus (type IIIB) had a lower signal intensity on MR images and slightly reduced disk heights. This type may represent an early stage of degeneration. Degenerated intervertebral disks (type IV) had either dense disorganized fibrous tissue or fluid replacing the normal fibrocartilaginous structure of the nucleus pulposus. MR images showed narrow intervertebral disk spaces with either reduced signal intensity if collagen was present or increased signal intensity if fluid was present. This study suggests that the nucleus pulposus may progress normally through types I, II, and III.     

Criteria for classifying normal and degenerated lumbar intervertebral disks

The purpose of this study was to develop criteria for distinguishing normal and degenerated lumbar intervertebral disks. Cryomicrotome sections from and magnetic resonance images of 31 cadavers were reviewed. The immature nucleus pulposus, found up to age 2 years; the transitional nucleus pulposus, found in teenagers; and the adult nucleus pulposus were associated with an intact anulus fibrosus without tears except for small concentric or transverse tears in the periphery of the anulus fibrosus. Discoloration of the nucleus pulposus, diminishing disk height, and diminishing signal intensity were associated consistently with a radial tear of the anulus fibrosus. The severely degenerated nucleus pulposus was associated also with a radial tear or complete disruption of the anulus fibrosus. The results suggest that intervertebral disk normally progresses from the immature to the transitional to the adult nucleus pulposus. When a radial tear develops in the anulus there is shrinkage and disorganization of fibrocartilage in the nucleus pulposus and replacement of the disk by dense fibrous tissue and cystic spaces.     

A reappraisal of the diagnosis in cervical disc disease: the posterior longitudinal ligament perforated or not

Summary Herniated nuclear material of the cervical disc often perforates the posterior longitudinal ligament. Of 22 patients who were operated on by an anterior approach, 10 were of this type (the subligamentous type of cervical disc protrusion), while in the remaining 12 patients and 15 discs the protruded disc caused no tear in the ligament (the epiligamentous type). Myelography and CT myelography of these patients were reviewed. On CT myelography a localized and sharply demarcated excavation of the metrizamide ring was commonly found in the subligamentous type. Myelographic lateral view in this group shows a moderate or large indentation of the metrizamide column, since the herniated nucleus pulposus sometimes migrates caudally or cephalically. A small myelographic deformity coupled with diffuse excavation of the metrizamide ring on a CT myelogram leads us to the diagnosis of the epiligamentous type of cervical disc protrusion. In such cases, excision of the ligament is unnecessary during exploration of the discs, except when there is marked depression in the posterior longitudinal ligament. Presurgical recognition of both anatomical processes must be stressed for anterior discectomy.     

髓核摘除大小与后路腰椎微创手术临床效果的相关性研究

目的：分析探讨髓核摘除大小与后路腰椎微创手术临床效果的相关性。方法选取2014年4月～2015年10月收治的83例腰椎间盘突出症患者,所有患者均行腰椎侧后路椎间孔镜髓核摘除术,根据患者术中的髓核摘除量分为甲乙两组,将髓核摘除量≥6立方厘米的患者分为甲组,共40例,将髓核摘除量＜6立方厘米的患者分为乙组,共43例。观察比较两组患者的临床病理情况以及行髓核摘除手术后的临床效果。结果两组患者末次随访的腰痛VAS评分、下肢VAS评分和ODI评分等均显著高于相应的术前评分（均P＜0．05）;并且两组患者的各项评分术前和末次随访相比均无明显差异（均P＞0．05）。而根据我院对两组患者术前、术后以及末次随访所记录的椎间隙高度进行统计分析,结果显示两组患者术前、术后以及末次随访等椎间隙高度变化均无明显差异,两组患者的数据比较差异不具有统计学意义（均P＞0．05）。结论在后路腰椎微创手术中,不需要刻意地追求髓核的摘除量,只需要对退变突出的责任髓核进行摘除以充分缓解对神经根的压迫即可。     

Progressive and regressive changes in the nucleus pulposus. Part I. The neonate

Magnetic resonance (MR) imaging, correlated with anatomic sections, was used to characterize the progressive and regressive changes in the nucleus pulposus in neonates. The spines of five fetuses and five full-term infants between 16 and 40 weeks old were studied. In anatomic sections, the nucleus pulposus was sharply demarcated from the anulus fibrosus, Sharpey fibers were conspicuous, and a plate of primitive notochord was evident in the equator of the disk. On long repetition time (TR)/long echo time (TE) or long TR/short TE MR images, Sharpey fibers (low signal intensity) and notochord (low signal intensity) could be differentiated from the high-signal-intensity nucleus pulposus and anulus fibrosus. The major differences between the fetal and infant spines were the amount of notochord in the disk and ossification in the vertebral body.     

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。     

The diagnosis of herniated intervertebral disks with MR imaging: a comparison of gradient-refocused-echo and spin-echo pulse sequences

Axial MR images of 65 lumbar disks with herniated nucleus pulposus imaged by gradient-refocused-echo (GRE) and spin-echo (SE) MR pulse sequences of 200-400/15 with a flip angle of 15-30 degrees was selected as optimal because of its high signal-to-noise ratio and good contrast between CSF, nucleus pulposus, and bone. The GRE technique was confirmed to be more sensitive in detecting prolapsed disks than the SE technique, but was less sensitive in demonstrating extruded disks. The combination of axial GRE and SE resulted in high detectability of herniated nucleus pulposus on axial MR images. Our results suggest that the GRE technique is an important adjunct to SE imaging in studying herniated nucleus pulposus.     

CT导引注射胶原酶治疗腰椎间盘突出症的临床研究

目的：探讨ＣＴ引导下椎间盘突出的髓核内和突出物表面注射胶原酶治疗椎间盘突出 的效果。方法：对９０例椎间盘突出的患者在ＣＴ导引下分别于椎间盘突出的髓核内和突出物的表达注射胶原酶,所有患者随访３个月￣２年,其中３０例行ＣＴ复查。结果：穿刺成功率１００％,术后随访３个月￣２年,优良率为９５．６％,２９例ＣＴ随访突出物 部分缩小或消失（９６．７％）,本组无并发症。结论”腰椎间盘突出的髓核内和突出物的表面共     

抗生素对人体椎间盘的渗透性研究

目的探讨抗生素对人体椎间盘的渗透性，为椎间盘炎的抗生素治疗提供理论依据。方法３２例腰椎间盘突出的病人随机分成四组，分别给予先锋霉素Ⅴ氟氯西林，妥布霉素，克林霉素静脉滴注３０分钟，给药完毕后，用经皮椎间盘术（ＰＬＤ）技术取髓核，同时抽取静脉血送检，用高效液相色谱系统测定标本的抗生素浓度。结果克林霉素、妥布霉素、先锋霉素Ⅴ在髓核内可达到有效抑菌浓度，氟氯西林未达到有效抑菌浓度。结论克林霉素、妥布霉素、先锋霉素Ⅴ可用于治疗椎间盘炎。