游离型腰椎间盘突出症34例分析

目的：探讨游离型腰椎间盘突出症的诊断及手术治疗效果。方法：对1990年2月－2001年3月手术治疗腰椎间盘突出症1250例中34例游离型腰椎间盘突出症进行分析。结果：术后平均随访年半，优27例，良6例，进步1例，差无，优良率97.1%。结论：游离型腰椎间盘突出症都有慢性腰腿痛病史，腰部再度受外伤后腰腿症状加剧，强迫体位，直腿抬高试验阳性，结合CT或MRI可明确诊断，一量确诊，应尽早手术减压，审十分重要的治疗原则。     

手术治疗脱垂游离型腰椎间盘突出症21例

目的 探讨脱垂游离型腰椎间盘突出症及手术治疗方法。方法 总结近10年我院21例脱垂游离型腰椎间盘突出症施行手术治疗的体会。结果 获得随访18例，随访3m-3．5年，按Macnab疗效评定标准，优良率88．9％。结论 脱垂游离型腰椎间盘突出症的临床表现及治疗方法有特殊性，术前需仔细检查、综合分析以免漏诊误诊，术中应仔细探查、小心剥离、彻底摘除退变游离的髓核方可解除症状。     

游离型腰椎间盘突出症的诊断和治疗——附48例报告

目的 提高对游离型腰椎间盘突出症的诊断治疗水平。方法 回顾分析48例手术证实的游离型腰椎间盘突出症的临床特点、影像学所见及治疗经过。结果 本症的发病年龄较轻,平均34．5岁,临床症状较复杂、疼痛较重,同时伴有括约肌功能障碍等。结论 临床表现及影像学所见提示为游离型腰椎间盘突出症,特别是有马尾神经损伤应尽早手术,清除游离的髓核组织。     

类似椎管内肿瘤的游离型腰椎间盘突出症的特点及治疗5例报告

腰椎间盘突出症是骨科常见病，根据临床表现及影像学检查一般能明确诊断，但有极少数破裂游离型腰椎间盘突出症的临床表现及影像学检查与椎管内肿瘤相似，不易鉴别：我院自1993．5-2003．5共收治3225例腰椎间盘突出症，破裂游离型腰椎间盘突出症232例。其中5例游离型病例在临床症状及影像学表现上与椎管内肿瘤相似，现报告如下。     

CT和脊髓造影对游离型腰椎间盘突出症的诊断价值

提高游离型腰椎间盘突出症的诊断有助于选择及指导手术治疗，具有重要的临床意义。作者比较了ＣＴ和脊髓造影术对游离型腰椎间盘突出症的诊断价值，报告如下。１临床资料１１一般资料从１９９３年到１９９５年手术治疗１４２例腰椎间盘突出症患者，男９４例，女４８例；...     

全椎板切除回植式髓核摘除术治疗腰椎间盘突出症

目的探讨全椎板切除回植式髓核摘除术治疗游离型腰椎间盘突出症的临床特点及疗效。方法回顾性研究28例游离型腰椎间盘突出症手术治疗的临床资料。全部病例均采用全椎板切除回植式髓核摘除术治疗。结果28例经6～54个月随访，平均21个月。据Macnab评定标准，优良率为92．9％。结论游离型腰椎间盘突出症是手术治疗的适应证，全椎板切除回植式髓核摘除术是治疗游离型腰椎间盘突出症的一种有效术式。     

游离型腰椎间盘突出12例分析

游离型腰椎间盘突出１２例分析胡金城李重茂统计我院１９９０年１月至１９９５年１２月手术治疗腰椎间盘突出症患者１６００余例，其中游离型腰椎间盘突出在椎管内不同程度游走１２例，占０７５％，经明确诊断、手术治疗，疗效满意，现报告如下：１临床资料本组男１０例...     

腰椎间盘突出症化学溶核术治疗术后复发的手术治疗体会

目的：探讨腰椎间盘突出症化学溶核术治疗术后复发的手术治疗体会。方法：分析9例腰椎间盘突出症化学溶核术后复发的临床资料和手术治疗资料。结果：突出型5例，其中钙化3例，脱出型3例，游离型1例。疗效：优，症状、体征消失，正常生活工作。本组5例；良，症状、体征基本消失，偶有放射性腿麻，本组3例；可，症状、体征明显改善，仍有足外侧麻木，本组1例。结论：化学溶核术治疗腰椎间盘突出症应严格适应证的选择。     

游离型腰椎间盘突出症的诊断与手术治疗

目的探讨游离型腰椎间盘突出症的临床诊断及手术治疗方法。方法通过对16例游离型腰椎间盘突出的患者进行手术治疗,评估影像学诊断意义,通过随访对治疗效果进行评价。结果核磁共振检查可明显提高游离型腰椎间盘突出症的诊断准确率,积极进行手术后可获得80%的治疗效果优良率。结论游离型腰椎间盘突出症存在一定的发生率,诊断明确后应早期手术,对于术前存在腰椎不稳、腰椎间盘手术术后复发、全椎板切除的情况可考虑同时行该节段的固定融合术。     

游离型腰椎间盘突出症CT诊断的评价

游离型腰椎间盘突出症ＣＴ诊断的评价王宵光沈耀良作者单位：２３３００４蚌埠医学院附属医院骨科提高游离型腰椎间盘突出症的诊断，有助于选择及指导手术治疗方案，具有重要的临床意义。本文探讨ＣＴ和脊髓造影术对游离型腰椎间盘突出症的诊断价值，报道如下。１临床资料...     

Posterior and anterior epidural and intradural migration of the sequestered intervertebral disc: Three cases and review of the literature

Context: Dorsal migration of the sequestered lumbar intervertebral disc is an unusual and underrecognized pattern of lumbar disc herniation associated with pain and neurological deficit.Findings: Three patients presented with lower limb- and low back pain. MR imaging showed intracanalicular mass lesions with compression of the spinal cord and allowed precise localization of lesions in the extradural or intradural space. Diagnosis was straightforward for the patients with the posterior and anterior epidural disc fragments, whereas various differential diagnostic considerations were entertained for the patient with the intradural mass lesion. All patients underwent surgical removal of the sequestered disc fragments, and recovered full motosensory function. Surgical repair of the dura mater due to CSF leak was required for the patient with intradural disc herniation.Conclusion/clinical relevance: Posterior and anterior epidural, and intradural disc migration may manifest with clinical symptoms indistinguishable from those associated with non-sequestered lumbar disc hernias. Missed, migrated disc fragments can be implicated as a cause of low back pain, radiculopathy or cauda equina syndrome, especially in the absence of visible disc herniation. A high index of suspicion needs to be maintained in those cases with unexplained and persistent symptoms and/or no obvious disc herniation on MR images.     

Is there a clinical correlate to the histological and radiological evidence of inflammation in trans-ligamentous extruded and sequestered lumbar disc herniaton?

The pain of lumbar disc herniation is related to direct compression of the nerve root and to the foreign-body inflammatory response to the herniated disc material. In this study, we attempted to identify disc-related inflammation in trans-ligamentous extruded and sequestered lumbar disc herniation using gadolinium-DPTA-enhanced T1-weighted and short-time inversion recovery (STIR) magnetic resonance imaging. We assessed how these results related to each other, and to patients' clinical status, and to immunohistochemistry findings in disc specimens removed at surgery. Forty-one patients with trans-ligamentous extruded or sequestered disc herniation were investigated clinically and radiologically. Twenty-five patients who did not respond to initial medical treatment or who had progressive neurological deficits underwent discectomy. Specimens of disc material removed during surgery were studied immunohistochemically and inflammatory cell types were identified. The other 16 patients showed good response to treatment, and were given further medical therapy and monitored for a mean of 6.3 months of follow-up. All radiological diagnoses in the operated cases were confirmed at surgery. There were no significant differences among the rates of detection of inflammation by contrast MRI, STIR technique, and immunohistochemistry in the surgical treated cases. In the medically treated cases, the frequency of radiological evidence of inflammation on the initial contrast enhanced T1-weighted and STIR images was similar to the frequency observed on the most recent scans done during follow-up. The study showed that the radiological and immunohistochemical evidence of inflammation in these cases does not correspond with patients' clinical pain profiles over time. It also revealed that STIR and contrast T1W are equally reliable for detecting inflammation in trans-ligamentous extruded or sequestered lumbar disc herniation. In future, studies that focus on physical and chemical mechanisms of pain in lumbar disc herniation in larger series of conservatively and surgically treated patients may clarify the link between inflammation and radicular pain in these types of disc herniation.     

后路椎间盘镜技术治疗游离型腰椎间盘突出症

目的研究腰椎后路椎间盘镜手术治疗游离型腰椎间盘突出症的手术方法、对策及效果。方法2000年9月至2004年6月利用后路腰椎间盘镜技术治疗游离型腰椎间盘突出症8例。结果8例患者均获得随访,时间9~54个月,平均27.2个月。本组优5例,良3例,优良率100%。本组病例无神经损伤、感染等并发症。结论采用腰椎后路椎间盘镜手术治疗,减压充分,损伤小,临床疗效满意。     

Effect of the transligamentous extension of lumbar disc herniations on their regression and the clinical outcome of sciatica

STUDY DESIGN: Magnetic resonance imaging of symptomatic herniated lumbar discs was investigated longitudinally and prospectively for the presence of tear in the posterior longitudinal ligament (PLL). OBJECTIVES: To clarify the effect of transligamentous extension through the PLL of herniated disc on its regression and to determine the factors contributing to a successful clinical outcome. SUMMARY OF BACKGROUND DATA: Greater regression of the herniated fragment has been noted with larger initial disc herniations. The exposure of herniated disc materials to the epidural vascular supply through the ruptured PLL has been suspected to play a part in the mechanism of disappearance of the herniated nucleus pulposus. However, it had not been shown clinically. METHODS: Clinical outcomes and magnetic resonance images of 36 patients with symptomatic lumbar disc herniations, treated conservatively, were analyzed. Patients were divided into three groups: subligamentous, transligamentous, and sequestered herniations. The size of the herniated disc was measured by herniation ratio, which is defined as the ratio of the area of herniated disc to that of the thecal sac on the axial view. Factors associated with the natural regression of herniated disc and the successful clinical outcome were explored. RESULTS: Of the 36 herniated discs, 25 decreased in size. Ten (56%) of 18 subligamentous herniations, 11 (79%) of 14 transligamentous herniations, and all 4 (100%) sequestered herniations were reduced in size. The average decreases in herniation ratio of the subligamentous, transligamentous, and sequestered disc groups were 17%, 48%, and 82% respectively. The decrease in herniation ratio was related to the presence of transligamentous extension but was not related to the initial size of herniation. Successful outcome correlated with a decrease in herniation of more than 20%. CONCLUSION: Transligamentous extension of herniated disc materials through the ruptured PLL is more important to its reduction in size than is the initial size of the herniated disc. Decrease in herniation ratio of more than 20% seems to correspond to successful clinical outcome.     

Lumbar disc excision in children and adolescents

STUDY DESIGN: The authors examined a case series of patients under the age of 18 years treated for lumbar intervertebral disc herniation. OBJECTIVES: To evaluate postoperative and long-term results of surgery in patients younger than 18 years. SUMMARY OF BACKGROUND DATA: There are only a few series, with controversial results, available on the surgical treatment of disc herniation in growing patients. METHODS: Between 1975 and 1991, a consecutive series of 129 patients 9-18 years of age (average age, 16.2 years) underwent surgery for lumbar intervertebral disc herniation. Low back pain associated with leg pain was the main clinical symptom in 106 subjects (82%), back pain in 17 (13%), and leg pain in 6 (5%). RESULTS: Short-term results were excellent or good for 123 cases (95%), with complete pain relief in 97 (75%) and moderate but incomplete relief in 26 (20%). A total of 98 (76%) long-term responses obtained at a mean follow-up of 12.4 years revealed excellent outcomes in 40% of the cases, good in 47%, and poor in 13%. Ten patients (10%) underwent reintervention after 9 years on average (2 fusions and 8 re-explorations for herniated disc). CONCLUSIONS: Results have confirmed a tendency for outcomes to deteriorate between the short-term and long-term follow-up in young patients treated by discectomy: this tendency and the rate of reintervention (10%) confirmed the need for long-term follow-up of children and adolescents treated for disc herniation.     

腰椎间盘突出症合并足下垂的外科治疗

目的：探讨腰椎间盘突出症合并足下垂的临床特点和外科治疗效果。方法：回顾分析我科1995年至2004年期间治疗的34例腰椎间盘突出症合并足下垂患者的临床资料，合并足下垂患者占同期同期收治腰椎间盘突出症1545例的2．2％。均行手术治疗，其中20例采用半椎板切除突出椎间盘摘除术，8例采用全椎板切除突出椎间盘摘除术，4例行间盘切除，椎弓根钉内固定，后外侧植骨融合术，另2例行内窥镜下病变节段椎间盘切除术。所有患者围手术期均辅以静脉滴注甲基强的松龙治疗。结果：术中可见受压神经根均有不同程度增粗，无并发症发生。术后随访3个月至5年，平均38个月，无复发病例。按患足背伸肌力较术前恢复程度评定，疗效优18例，良12例，可2例，无恢复2例。结论：腰椎间盘突出症合并足下垂患者选择合理的手术方式，围手术期应用甲基强的松龙，治疗效果较好。     

射频消融髓核成形术治疗腰椎间盘突出症

目的：探讨射频消融髓核成形术治疗腰椎间盘突出症的手术技巧、疗效和适应证。方法：对86例腰椎间盘突出症患者采用经皮穿刺射频消融髓核成形术(nucleoplasty)治疗，并对其疗效进行观察分析。结果：86例患者经3～18个月随访，根据“中华医学会骨科分会脊柱学组腰背痛手术评定标准”，术后疗效优10例，良65例，可6例，差3例，优良率87．2％，有效率为96．5％。无相关并发症发生。结论：射频消融髓核成形术操作简单、安全，是治疗腰椎问盘突出症的有效微创手术。     

青少年腰椎间盘突出症的手术治疗

目的：探讨青少年腰椎间盘突出症的手术治疗方法及效果。方法：对14例经保守治疗无效或临床症状特别严重的青少年腰椎间盘突出症患者进行单侧或双侧椎板开窗减压腰椎间盘髓核摘除术，观察治疗效果。结果：全部病例获得随访，随访时间2个月-11年，平均4年2个月，11例术后症状完全消失，恢复正常工作与生活，无复发；2例术后症状基本消失，但仍有轻微腰部不适，劳累后出现腰痛，短暂休息后症状消失，不影响正常工作；1例术后症状明显减轻，体征大部分消失，但未能恢复正常体力活动。结论：青少年腰椎间盘突出患者突出物较大且神经损害症状较重，保守治疗不能取得满意疗效时应尽早采用单侧或双侧椎板开窗手术，手术治疗效果满意。     

Types of lumbar herniated disc and clinical course

STUDY DESIGN: A retrospective study of different types of herniated discs and duration of symptoms in patients with lumbar disc herniation, and a trial of longer conservative treatment to reduce the number of operations. OBJECTIVE: To determine whether noncontained and contained herniated discs have different clinical courses and to evaluate the results of the clinical trial of longer and vigorous conservative treatment. SUMMARY OF BACKGROUND DATA: The possibility of a difference in clinical features between contained and noncontained disc herniation has been suggested previously. METHODS: In the first study, the medical history and intraoperative findings of 156 patients who had undergone herniotomy were reviewed. In the second study, conservative treatment of at least 2 months' duration was recommended for all patients with lumbar disc herniation. RESULTS: In the first study, patients with noncontained disc herniation had a shorter preoperative clinical course than those with contained disc herniation. It was rare for noncontained herniation to require surgery 4 months or more after the onset of symptoms. In the second study, the authors' protocol reduced the number of herniotomies required, especially the number of operations for the patients with noncontained disc herniation. CONCLUSIONS: The authors believe that patients with noncontained lumbar disc herniation can be treated without surgery, if these patients can tolerate the symptoms for the first 2 months.     

按压微调法治疗腰椎间盘突出症的临床研究

目的：探讨按压微调法治疗腰椎间盘突出症的治疗效果。方法选取我院2012年3月～2014年3月收治的腰椎间盘突出症患者323例,随机分为常规组及治疗组,常规组腰椎间盘突出症患者给予常规的传统推拿治疗,治疗组腰椎间盘突出症患者在此基础上给予按压微调法治疗,治疗为期1个月,1个月后对比两组腰椎间盘突出症患者的恢复情况以及VAS疼痛评分。结果治疗组患者的恢复情况比常规组患者的恢复情况明显好,同时治疗组患者的VAS疼痛评分明显比常规组患者的VAS疼痛评分低。结论按压微调法治疗腰椎间盘突出症疗效显著,在临床治疗中具有重要意义。