腰椎间盘突出症合并椎管狭窄23 例治疗分析

目的探讨经后路椎间盘镜手术治疗合并腰椎管狭窄症的椎间盘突出症的临床应用。方法采用后路椎间盘镜进行单侧开窗减压术。通过术前标记腰椎正侧位片定位，于定位棘突间隙后正中偏患侧作长约1.5 cm小切口，逐级扩张后置入工作通道管，钻除部分椎板，置入内窥镜，于电视监视器下显露椎板、增生内聚的关节突、肥厚的黄韧带及突出的椎间盘髓核组织，彻底解除其对硬脊膜、神经根的压迫。结果本组共治疗合并腰椎管狭窄症的腰椎间盘突出症23例，平均随访7个月，按Prolo标准评定，治愈20例，有效2例，无效1例。结论本术式在严格掌握适应证前提下对合并腰椎管狭窄症的腰椎间盘突出症患者效果明显。     

后路椎间盘镜手术治疗腰椎管狭窄症

目的探讨后路椎间盘镜手术治疗腰椎管狭窄症的临床应用和适应证。方法采用后路椎间盘镜手术系统进行单侧开窗、双侧开窗、多节段局部开窗减压术对腰椎管狭窄症患者进行手术治疗,术中通过C型臂X线机定位,于腰部后正中做1个长约1.8 cm的小切口,安全钻在椎板开骨窗,置入工作通道,在电视监视下显露并清除椎板、增生内聚的关节突、肥厚的黄韧带及突出的髓核组织,彻底解除其对神经根和硬膜的压迫。结果56例患者均有明显改善。本组病例随访1~42个月,其功能恢复按照参考文献标准评定效果,本组优47例(83.9%),良6例(10.8%),可3例(5.3%)。结论后路椎间盘镜手术治疗腰椎管狭窄症在保证神经充分减压的前提下,可减少创伤,保持脊柱的稳定性,适用于单节段或多节段腰椎管狭窄症及合并腰椎间盘突出的患者。     

后路椎间盘镜在治疗腰椎管狭窄症中的应用

目的：探讨后路椎间盘镜在治疗腰椎管狭窄症中的应用。方法：2000年2月--2001年12月退行性腰椎管狭窄症142例行后路椎间盘镜下椎管有限减压、全椎板或半椎板切除减压、开窗减压术。结果：应用后路椎间盘镜行椎管有限减压87例，减压松解充分。82例随访平均18月，优良率92．7％(优58例，良18例)。无并发症。结论：单纯腰椎间盘膨出或突出、黄韧带肥厚和小关节增生引起的退行性腰椎管狭窄症是后路椎间盘镜下椎管有限减压的适应证。满意的手术效果取决于：病人选择适当，术中操作精细，减压彻底。     

后路椎间盘镜显微治疗腰椎椎管狭窄症

目的 报道显微后路椎间盘镜治疗退行性腰椎椎管狭窄症的临床效果。方法 选取退行性腰椎管狭窄症病例，椎板间隙入路椎间盘镜下行椎管减压，单侧单节段开窗减压23例，双侧单节段开窗减压12例，单侧双节段开窗减压9例，单侧双节段半椎板切除减压4例。结果 除1例术中硬膜破裂改常规手术外，其余病例均在手术显微镜下完成腰椎管减压术。所有病例获得5～18个月随访，平均8．3个月，优良率92％。结论 显微后路椎间盘镜治疗退行性腰椎管狭窄症具有手术创伤小、神经根减压彻底、术后恢复快的特点；单纯腰椎间盘膨出或突出、黄韧带肥厚和小关节增生引起的退行性腰椎管狭窄症是其适应证。     

多孔开窗治疗腰椎管狭窄症合并椎间盘突出症疗效分析

多孔开窗治疗腰椎管狭窄症合并椎间盘突出症疗效分析陈庄洪唐运章蔡贤华邵振海黄继锋腰椎管狭窄症合并椎间盘突出症是引起腰腿痛常见原因，常用的手术方法有全椎板、半椎板与椎板间开窗减压髓核摘除术。九十年代以来，我院手术治疗腰椎管狭窄并发腰椎间盘突出症１６８例...     

采用KS-I型后路椎间盘镜治疗腰椎管狭窄症92例初步观察

目的：探讨经后路椎间盘镜手术治疗腰椎管狭窄症的临床应用和适应证。方法：采用KS-I型后路椎间盘镜进行单侧“开窗”、双侧“开窗”、多阶段局部“开窗”减压术等。术中通过“C”形臂X线机或摄侧位X线片定位,于后正中做l-3个长约1．5cm互不相连的小切口,逐级扩张后直入工作通道管,钻除部分椎板,置入内窥镜,于电视监视器下显露并清除椎板、增生内聚的关节突、肥厚的黄韧带及突出的椎间盘髓核组织,彻底解除其对硬脊膜、神经根的压迫。结果：本组共治疗腰椎管狭窄症92例,平均随访7个月,按Nakai标准评定,优77例,良9例,可l例,差2例。优良率为96．6％(86／89)。3例转为开放式手术。结论：本术式在保证神经充分减压的前提下,可减少创伤．保持脊柱的稳定性。本方法适用于单节段或多节段腰椎管狭窄症及合并腰椎间盘突出的患者。     

椎间盘镜系统治疗腰椎间盘突出症与腰椎管狭窄症58例报告

目的　报告了在间盘镜下微创治疗腰椎间盘突出症及腰椎管狭窄症的方法、体会。方法对 5 8例腰椎间盘突出合并腰椎管狭窄症患者 ,成功地进行了间盘镜下髓核切除术 ,椎管狭窄减压术。结果　术后症状、体征完全消失 5 0例 ,基本缓解 8例 ,优良率 93.3%。结论　间盘镜下可完成腰椎间盘突出合并腰椎管狭窄症的治疗 ,但巨大中央型突出并钙化不适用于后路椎间盘镜操作。     

显微内窥镜治疗合并腰椎管狭窄症的椎间盘突出症

目的 探讨后路显微内窥镜经椎板间隙入路行椎间盘摘除术及神经根管扩大术治疗腰椎间盘突出症合并腰椎管狭窄的技术特点和效果分析.方法 对68例腰椎间盘突出症合并腰椎管狭窄应用后路显微内窥镜系统行髓核摘除及神经根管减压手术治疗.结果 60例随访3～48个月,按Nakai标准评定:优43例,良13例,可3例,差1例,优良率93....     

椎板间隙入路椎间盘镜治疗腰椎管狭窄症

目的：探讨在椎板间隙入路椎间盘镜下有限化手术治疗退行性腰椎管狭窄症。方法：选取退行性腰椎管狭窄症病例，在椎板间隙入路椎间盘镜下行椎管有限减压。咬除病变间隙上位椎板下缘、肥厚的黄韧带和下位椎板上缘，摘除突出椎间盘髓核，松解神经根粘连，侧隐窝减压，必要时切除部分关节突。结果：应用椎板间隙入路椎间盘镜治疗迟行性腰椎管狭窄症，行椎管有限减压87例，减压彻底。82例得到随访，优良串92．7％，手术效果满意。结论：单纯腰椎间盘膨出或突出、黄韧带肥厚和小关节增生引起的退行性腰椎管狭窄症是椎板间隙入路椎间盘镜下椎管有限减压的适应证。满意的手术效果取决于：病人选择适当，术中操作精细，减压彻底。     

腰椎管成形术治疗腰椎管狭窄并椎间盘突出症

目的　介绍一种治疗腰椎管狭窄并椎间盘突出症的治疗方法。方法　应用单开门手术治疗腰椎管狭窄并椎间盘突出症 2 4例 ,其中单个椎板成形 18例 ,两个椎板成形 5例 ,3个椎板成形 1例。结果　术后随访 8个月— 3年 ,X线示半侧椎板小关节融合良好 ,1例再关门 ,优 16例 ,良4例 ,可 4例。结论　单开门腰椎管成形术治疗腰椎管狭窄并椎间盘突出可减少创伤 ,增加脊柱稳定性及防止瘢痕粘连 ,是一种有效的方法。     

腰椎不稳和腰椎滑脱的相关问题

<正>腰椎不稳或腰椎滑脱是导致腰腿痛的常见病因之一。然而在临床上,有关不稳和滑脱的界定、两者之间的关系、影像学诊断、治疗方案的合理选择、滑脱的复位等     

Degenerative lumbar spinal stenosis and lumbar spine configuration

As life expectancy increases, degenerative lumbar spinal stenosis (DLSS) becomes a common health problem among the elderly. DLSS is usually caused by degenerative changes in bony and/or soft tissue elements. The poor correlation between radiological manifestations and the clinical picture emphasizes the fact that more studies are required to determine the natural course of this syndrome. Our aim was to reveal the association between lower lumbar spine configuration and DLSS. Two groups were studied: the first included 67 individuals with DLSS (mean age 66 ± 10) and the second 100 individuals (mean age 63.4 ± 13) without DLSS-related symptoms. Both groups underwent CT images (Philips Brilliance 64) and the following measurements were performed: a cross-section area of the dural sac, vertebral body dimensions (height, length and width), AP diameter of the bony spinal canal, lumbar lordosis and sacral slope angles. All measurements were taken at L3 to S1. Vertebral body lengths were significantly greater in the DLSS group at all levels compared to the control, whereas anterior vertebral body heights (L3, L4, L5) and middle vertebral heights (L3, L5) were significantly smaller in the LSS group. Lumbar lordosis, sacral slope and bony spinal canal were significantly smaller in the DLSS compared to the control. We conclude that the size and shape of vertebral bodies and canals significantly differed between the study groups. A tentative model is suggested to explain the association between these characteristics and the development of degenerative spinal stenosis.     

Posterior lumbar interbody fusion and segmental lumbar lordosis

Introduction

The sagittal plane of body produces a convex curve anteriorly referred to as the lordotic curve. Malalignment of lordotic curve leads to low back disorders and lumbar spinal surgery has been known to cause this. This study was a retrospective analysis of the effects of posterior lumbar interbody fusion using cages on segmental lumbar lordosis.

Materials and methods

We conducted a retrospective study involving 27 patients of which 16 were females and 11 were males. All patients underwent single level posterior lumbar interbody fusion with insertion of non-wedged intervertebral cage and pedicle screw fixation. Intraoperatively, all patients had a change from knee chest position to prone to augment their lumbar lordosis. The minimum follow up was 2 years and fusion was achieved in 21 patients.

Results

Segmental lordotic angles increased from 15.2° to 20.6° at L4/5 level and from 17.8° to 24.5° at L5/S1 level, preoperative to postoperative, respectively (P < 0.01 at both levels).

Conclusion

Thus apparently, posterior lumbar interbody fusion with insertion of non-wedged intervertebral cage and pedicle screw fixation results in creation and maintenance of lumbar lordosis.     

经皮全脊柱内镜技术治疗腰椎间盘突出症

[目的]研究经皮全脊柱内镜技术(percutaneous endoscopic lumbar discectomy,PELD)治疗腰椎间盘突出症的临床疗效及安全性。[方法]回顾性研究2013年1月~2015年1月连续接受手术治疗的153例单节段伴有单侧神经根性症状的腰椎间盘突出症患者,其中68例行经皮全脊柱内镜下腰椎间盘髓核摘除术(内镜组),85例行开放腰椎间盘髓核摘除术(开放组)。采用视觉模拟评分法(VAS评分)、Oswestry功能障碍指数(ODI)、Mac Nab评分评定疗效。[结果]所有患者均完成手术,内镜组有1例出现神经根损伤。其他患者未发生神经、血管损伤等严重并发症。内镜组手术时间大于开放组,术中出血量、切口长度小于开放组,差异均有统计学意义(P0.05)。术后3 d和末次随访时腰痛VAS评分内镜组显著小于开放组,差异有统计学意义(P0.05),术后3 d腿痛VAS评分内镜组小于开放组,差异有统计学意义(P0.05),末次随访时两组腿痛VAS评分差异无统计学意义(P0.05)。内镜组末次随访时ODI指数小于开放组,差异有统计学意义(P0.05),两组疗效优良率差异无统计学意义(P0.05)。两组术后腰痛、腿痛VAS评分显著小于术前,差异有统计学意义(P0.05),内镜组术后3 d和末次随访时腰痛、腿痛VAS评分差异无统计学意义(P0.05)。开放组术后3 d和末次随访时腰痛VAS评分差异无统计学意义(P0.05),末次随访时腿痛VAS评分小于术后3 d,差异有统计学意义(P0.05)。[结论]经皮全脊柱内镜下腰椎间盘髓核摘除术治疗腰椎间盘突出症安全有效,创伤小,恢复快,是开放腰椎间盘髓核摘除术很好的替代技术。     

经椎间孔入路与经后方入路椎间融合术治疗退变性腰椎失稳症的疗效比较

目的回顾性研究经后方入路椎体间融合术（posterior lumbar interbody fusion,PLIF）和切除上、下关节突的经椎间孔入路椎体间融合术（transforaminal lumbar interbody fusion,TLIF）治疗腰椎失稳症的疗效及并发症情况。方法采用PLIF和TLIF治疗2004年1月至2008年1月本院收治的退变性腰椎失稳症患者78例,其中PLIF31例,TLIF47例。比较两组手术时间、术中出血量、平均卧床时间、Nakai评分优良率、融合时间（按Suk标准）及术后并发症发生率。对两组术前及末次随访时的椎间隙高度及椎间孔高度进行对比研究。结果 78例患者均获随访,随访时间1.5～4.5年,平均3.5年。所有患者均获椎间骨性融合。对两组卧床时间、Nakai评分优良率、融合时间、同时间点椎间隙高度和椎间孔高度进行比较,差异无统计学意义（P〉0.05）;而在手术时间、出血量以及术后并发症发生率方面,两组之间的差异有统计学意义（P〈0.05）。两组末次随访时的椎间隙高度和椎间孔高度均较术前有明显改善（P〈0.05）。结论 TLIF和PLIF治疗退变性腰椎失稳症效果良好;与PLIF相比,TLIF操作简单,出血量小,并发症少。     

腰椎滑脱和腰椎不稳的诊断和治疗

<正>腰椎滑脱症和腰椎不稳是目前临床上最为常见的腰椎疾患。在同一个病例中,两种病变经常同时存在,但两种病变的概念是有区别的,腰椎滑脱应是一种静态概     

Percutaneous lumbar discectomy in the treatment of lumbar discitis

Lumbar disc infection, either after surgical discectomy or caused by haematogenous spread from other infection sources, is a severe complication. Specific antibiotic treatment has to be started as soon as possible to obtain satisfactory results in conservative treatment or operative fusion. The aim of this study was to analyse 16 cases of lumbar disc infection, treated with percutaneous lumbar discectomy (PLD) to obtain adequate amounts of tissue for histological examination and microbial culture. Between 1990 and 1994, 26 patients with vertebral osteomyelitis were treated. Sixteen patients, with an average age of 41.4 years (range 14–59 years), underwent a diagnostic PLD. Eight of them showed only moderate changes on computed tomograms (CT scans) and magnetic resonance (MR) images in the initial stages of the disease. The other eight showed more or less extensive osteolytic lesions of one or both vertebral bodies adjacent to the involved disc. The histology results showed non-specific discitis in nine patients and tuberculosis in one. In two patients an open biopsy had been performed, which showed non-specific discitis. Microbiological analysis revealed specific infection in 45% of the patients. These patients received a specific antibiotic treatment after antibiogram for an average of 33 days. Only three patients were treated surgically, with evacuation of the disc space and interbody fusion; the whole group received a spondylitis brace. All patients obtained satisfactory clinical results at the last follow-up regarding pain, mobility and spontaneous fusion of the involved disc space. In conclusion, PLD is a very helpful minimally invasive procedure in conservative treatment of lumbar discitis.     

腰椎滑脱与腰椎不稳的诊疗

<正>腰椎滑脱和腰椎不稳虽然为临床中的常见疾病,但目前对其诊断和治疗仍存在诸多问题需要理清、界定和探讨,当然存在的争议问题也不是本文浅谈片语能够解决的。立足目前许多专家学者对腰椎滑脱和腰椎不稳的观点阐述[1-7],笔者仅对腰椎滑脱和腰椎不稳典型的几个问题梳理如下。1腰椎滑脱和腰椎不稳的诊断脊椎滑脱的英文名称为spondylolysis,其字根来源于希腊语,spondylo(椎体)和listhesis(滑移)。两个     

经椎间孔椎体间植骨治疗下腰椎爆裂性骨折

目的 探讨在下腰椎爆裂性骨折中应用单一后路经椎间孔椎体间植骨融合术重建椎体前中柱的有效性.方法 2009年1月～2011 年6月,采用单一后路切开复位椎弓根内固定经椎间孔椎体间植骨融合术治疗下腰椎爆裂性骨折19例.分别评价术前、术后、末次随访时的影像学指标变化,及术前与术后末次随访时神经功能变化.结果 19例患者平均随访15.6 个月.所有患者术后未发生切口感染、神经功能损伤及内固定器松动断裂等并发症.末次随访时18例患者证实椎间融合,19例患者术前平均伤椎高度为正常椎体高度的（40.62±12.32）%,术后恢复至（96.52±10.62）%,末次随访时为（95.43%9.54）%.腰椎前凸角术前32.2°±5.1°,术后38.4°±5.2°,末次随访时为38.4°±7.2°.末次随访时伴有神经功能障碍的患者均有1级以上的恢复.结论 下腰椎爆裂性骨折行后路椎弓根螺钉内固定经椎间孔椎体间植骨融合术,能完成短节段三柱固定,同时修复了前柱及矫正脊柱后凸,取得满意的骨性融合率.     

后路腰椎椎体间融合术治疗腰椎滑脱的临床疗效

目的：探讨后路腰椎椎体间融合术（posterior lumbar interbody fusion,PLIF）治疗腰椎滑脱的中期疗效,对腰椎滑脱症的临床治疗提供指导意见。方法回顾性分析采用PLIF治疗的腰椎滑脱40例,所有病例随访观察＞3年,对手术前后影像学资料、Oswestry功能障碍指数（Oswestry disability index,ODI）、视觉模拟量表（visual analog scale ,VAS）评分及日本骨科学会（Japanese Orthopaedic Association ,JOA）腰背痛手术治疗评分标准的评分变化情况进行比较分析。结果椎间隙高度、椎间孔高度术后1年、3年与术前比较差异均有统计学意义（P＜0．05）;术后1年与术后3年测量值比较差异不具有统计学意义（P＞0．05）。 ODI、腰痛VAS评分、腿痛VAS评分及JOA评分术前和术后1年、3年比较差异具有统计学意义（P＜0．05）;术后1年与术后3年比较差异不具有统计学意义（P＞0．05）。结论 PLIF手术能够恢复腰椎序列稳定性,改善临床症状,是治疗腰椎滑脱的理想术式,中期随访疗效满意。