改良骶管注射三联用药治疗老年人下腰段腰椎间盘突出症临床研究

目的探讨改良骶管三联注射药物治疗老年人下腰段腰椎间盘突出症的临床效果。方法选取该科2011-11~2014-06住院和门诊的下腰段腰椎间盘突出症患者84例,分为治疗组和对照组各42例。治疗组先采用利多卡因5 ml、地塞米松5 mg、维生素B120.5 mg、42~45℃生理盐水20 ml进行骶管内注射(第一针);然后再采用利多卡因5 ml、地塞米松5 mg、42~45℃生理盐水10 ml骶管内注射(第2针)。1次/3 d,3次为1个疗程。对照组采用推拿治疗,1次/d,10次为1个疗程。结果两组不同时间的VAS评分之间差异有统计学意义(F时点=9.76,P时点=0.00),治疗后10 d的VAS评分值最低;治疗组和对照组的VAS评分之间差异有统计学意义(F组间=5.63,P组间=0.01);治疗组的VAS评分低于对照组,不同分组不同时间之间存在交互作用(F组间×时点=5.44,P组间×时点=0.01)。治疗组治愈26例,显效14例,无效2例。对照组治愈15例,显效20例,无效7例。治疗组临床疗效优于对照组(Z=-2.574,P=0.010)。结论改良骶管注射三联用药治疗老年人下腰段腰椎间盘突出症安全可靠,疗效显著,可在门诊治疗中推广应用。     

CT引导臭氧消融术在腰椎间盘突出症中的应用

目的探讨CT引导下臭氧注射治疗椎间盘突出症的方法及临床应用价值。方法对300例腰椎间盘突出症患者在CT引导下经皮穿刺行臭氧治疗,采用盘内及突出物中央注射臭氧5～20ml,浓度为60μg/ml,椎间孔附近注射臭氧5ml,浓度为40μg/ml。结果注射臭氧后即行CT扫描显示:臭氧在盘内分布呈裂隙状、积聚状、弥散分布状及大部分溢出盘外状。治疗后随访3～12月,依据MaCNab标准,显效174例,占54%,有效102例,占32%,无效42例,占14%,总有效率为86%,术后无并发症。结论 CT定位引导穿刺操作简单,在严格掌握适应证前提下,经皮注射臭氧治疗腰椎间盘突出症是一种有效、安全的方法。     

骶管内注药加腰椎牵引治疗腰椎间盘突出症

我院自1985年以来采用骶管内注药加腰椎牵引治疗腰椎间盘突出症56例(男41例,女15例),年龄21～71岁,均经X线摄片或CT确诊。1.治疗方法及结果:5%葡萄糖5～8ml、利多卡因3mg/kg、布比卡因0.5～1mg/kg、强的松龙75mg、维生素B_(12)1250μg、维生素B_6200mg、注射用水20ml。患者侧卧,髋膝屈曲,消毒皮肤,     

经椎间孔椎体间融合术治疗复发性腰椎间盘突出症疗效观察

目的：观察经椎间孔椎体间融合术治疗复发性腰椎间盘突出症的临床疗效。方法44例复发性腰椎间盘突出症患者,行经椎间孔椎体间融合术,采用下肢疼痛VAS、ODI评分和腰椎JOA评分进行术后临床效果评估。结果手术时间（134．9±44．1）min,估计出血量（386．6±199．1）mL,住院时间（13．0±3．8）d,随访（7．7±4．7）个月。术后出现脑脊液漏6例,一过性单侧肌力下降2例,随访时均有所恢复。与术前比较,随访时下肢VAS、ODI评分降低,腰椎JOA评分升高,P均＜0．01。结论经椎间孔椎体间融合术治疗复发性腰椎间盘突出症有效。     

低分子右旋糖酐联合丹红注射液治疗急性脑梗死疗效观察

目的 观察低分子右旋糖酐联合丹红注射液(步长制药)治疗急性脑梗死临床疗效.方法 将60例急性脑梗死患者随机分成两组,治疗组30例采用丹红30ml加入5%葡萄糖注射液250ml或0.9%氯化钠注射液250ml静注滴注,1次/d,联合低分子右旋糖酐500ml静注滴注,1次/d,15d为1个疗程;对照组30例采用血塞通400mg加入5%葡萄糖注射液250ml静脉滴注,1次/d,15d为1个疗程.观察两组治疗前后神经功能缺损程度评分(SSS),日常生活能力(ADL)评分及疗效.结果 治疗组总有效率为91.4%,对照组为62.3%,治疗组疗效优于对照组(P＜0.05);两组治疗后SSS及ADL评分较治疗前均明显改善(P＜0.01).结论 低分子右旋糖酐联合丹红注射液治疗急性脑梗死疗效明显,值得临床推广.     

经后路腰椎融合术治疗老年性腰椎间盘突出症的临床疗效

目的 回顾性分析经后路腰椎融合术(PUF)治疗老年性腰椎间盘突出症的临床疗效.方法 2004年1月至2011年1月,对68例老年腰椎间盘突出症患者行PLIF治疗.结果 2例患者术后出现暂时性神经根牵拉症状,椎体间植骨融合67例,不融合1例.所有患者术前症状均获不同程度缓解,无其他远期并发症、无复发.VAS评分:术后、末次随访较术前均有统计学差异(P＜0.01);ODI指数:末次随访较术前有统计学差异(P＜0 01);腰椎融合率:98.5％.结论 PLIF治疗老年性腰椎间盘突出症、尤其伴有腰椎不稳或椎管狭窄患者具有较好临床疗效,是治疗老年性腰椎间盘突出症的一种较佳选择.     

倍他司汀联合血栓通注射液治疗眩晕症的临床观察

目的观察倍他司汀联合血栓通注射液治疗眩晕症的临床疗效。方法将65例眩晕症患者随机分为治疗组和对照组,均给予静脉滴注盐酸倍他司汀氯化钠注射液250ml,1次/d,治疗7d;治疗组在上述治疗基础上加用血栓通注射液0.4g（加入5%葡萄糖注射液250ml）静脉滴注,1次/d,治疗7d。结果治疗组患者大脑中动脉（MCA）、大脑前动脉（ACA）、大脑后动脉（PCA）血流情况较对照组改善显著,椎动脉颅内段（VA）、基底动脉（BA）血流速度比对照组有明显的改善;治疗组总有效率为93.94%,对照组总有效率为75.0%,两组总有效率间差别具有统计学意义（P〈0.05）。结论倍他司汀联合血栓通注射液可提高眩晕症的临床疗效,不良反应少,耐受性好。     

腺苷蛋氨酸联合异甘草酸镁治疗瘀胆型肝炎45例

[目的]观察腺苷蛋氨酸联合异甘草酸镁治疗瘀胆型肝炎的疗效。[方法]90例患者随机分为2组各45例,治疗组采用腺苷蛋氨酸冻干粉针剂1 000 mg加入5%葡萄糖250 ml静脉滴注,1次/d,异甘草酸镁注射液100mg加入10%葡萄糖250 ml静脉滴注,1次/d;对照组采用苦黄注射液30 ml加入10%葡萄糖250 ml静脉滴注,1次/d,甘草酸二铵注射液150 mg加入10%葡萄糖250 ml静脉滴注,1次/d,疗程均为4周。观察患者治疗前后的症状和肝功能变化,并记录治疗过程中的不良反应。[结果]治疗组总有效率95.6%,优于对照组77.8%,2组比较差异有统计学意义（P〈0.05）。治疗组治疗后肝功能指标均较治疗前改善（P〈0.05）,且各指标改善情况均优于对照组（P〈0.05）。[结论]腺苷蛋氨酸联合异甘草酸镁治疗瘀胆型肝炎临床疗效明显。     

O2～O3混合气体盘内外注射消融治疗腰椎间盘突出症临床研究

目的探讨O2～O3混合气体椎间盘内外注射治疗腰椎间盘突出症的临床疗效。方法65例腰椎间盘突出症患者在透视下用21G酒精针穿刺病变椎间盘内并注射浓度为50μg/ml的O2～O3混合气体8—10ml;针退至椎间孔并注射浓度为30—40μg/ml的O2～O3混合气体15～20ml。术后2个月评估治疗效果。结果65例患者均穿刺成功,注入O2～O3混合气体后大部分患者均立即感到症状有不同程度缓解,未发生不良反应及其他并发症。术后2个月优良率75．3％。结论经皮椎间盘内外注射O2～O3混合气是治疗腰椎间盘突出症的一种安全有效的微创疗法。     

侧隐窝阻滞联合超激光照射治疗腰椎间盘突出症60例疗效观察

目的观察侧隐窝注射消炎镇痛药物配合超激光照射治疗腰椎间盘突出症的疗效及安全性。方法将同期收治的120例腰椎间盘突出症患者随机分为观察组和对照组各60例,观察组采用2％利多卡因5ml＋甲钴胺1mg＋得宝松3．5mg＋生理盐水至20ml（1U）配制而成的消炎镇痛液行侧隐窝阻滞,同时辅助超激光照射;对照组采用上述消炎镇痛液行传统骶管阻滞。疗程结束后1周～12个月观察两组疗效及不良反应发生情况。结果两组均无明显不良反应发生,观察组疗程结束后1周～12个月总有效率均显著高于对照组（P〈0．01）。结论侧隐窝阻滞联合超激光治疗腰椎间盘突出症安全、有效。     

Degenerative lumbar stenosis

Stenosis is a condition that is not recognized as frequently as it should be. The diagnosis should be suspected primarily on the basis of bizarre history and physical findings. Myelography is diagnostic. Surgical decompression is the treatment of choice in severe cases. Considerable clinical and experimental investigation remains to be done if we are to further understand the cause, institute efficacious preventive measures, and achieve more success in the treatment of degenerative lumbar stenosis and other spinal afflictions.     

腰椎后路椎间融合与后外侧融合治疗腰椎退行性疾病疗效比较的meta分析

目的 系统评价后外侧融合与后路椎体间融合两种融合方式治疗腰椎退行性疾病的疗效。方法按Cochrane系统评价方法,计算机检索Cochrane图书馆（2012年第1期）、Medline（1966~2012.3）、EMBASE（1988~2012．3）、中国生物医学文摘数据库（1986~2012.4）,并手工检索相关杂志收集后外侧融合与后路椎体间融合治疗腰椎退行性疾病疗效对比的随机对照试验。评价纳入研究的方法学质量,采用RevMan5软件进行Meta分析。结果纳入4篇随机对照试验,共329例腰椎退行性疾病患者。Meta分析结果显示,后路椎间融合组术中及术后24h总出血量明显少于后外侧融合组【加权均数差值（WMD）320．03,95％CI241．26~398．79],差异有统计学意义（P〈O．00001）。后路椎间融合组融合率高于后外侧融合组（OR0．41,95％C10．19～0．85）,差异有统计学意义（P=0．02）。后路椎间融合组对腰背痛缓解优于后外侧融合组（WMD0．43,95％C10．10～0．76）,差异有统计学意义（P=0．01）。两组Oswestry功能障碍指数（WMD2．86,95％CI-0．56～6．26）、术后腿痛视觉疼痛评分（WMD0．34,95％CI-0．11～0．79）、术后腰椎前凸角度（WMD-2．43,95％CI-5．42～0．55）差异均无统计学意义。结论在治疗腰椎退行性疾病中,后路椎间融合组较后外侧融合组有更高的融合率,能更好的缓解腰部疼痛,且术中及术后24h内总出血量少。但仍需要设计良好、方法学质量更高的随机对照试验进一步验证。     

Ascending lumbar venography in the diagnosis of lumbar disc lesions.

Fifty-five patients suffering from low back pain with or without sciatica were submitted to ascending lumbar venography. Six patients had anatomical variations which prevented adequate catheterization and 6 had equivocal radiographic appearances, which we could not assess. Fourteen patients had normal venograms but in 29 an abnormality was demonstrated. These 43 patients were then submitted to radiculography and, where appropriate, surgery. The 14 patients with normal venograms also had normal radiculograms; while the 29 with abnormal venograms had an abnormality confirmed on radiculography and/or surgery. However, in 10 of the patients the lesion was found to be one disc space lower than that demonstrated on venography; Side-effects were very few, and the procedure can be used on out-patients. This technique would appear to be a useful addition to the radiological investigation of the spine.     

复发性腰椎间盘突出合并腰椎不稳的再手术治疗

目的探讨复发性椎间盘突出合并腰椎不稳患者的发生原因及治疗效果。方法32例复发性椎间盘突出合并明显腰椎不稳的患者再次翻修手术采用扩大椎管减压、椎间植骨、椎弓根螺钉内固定方式进行治疗。术后对所有患者进行Oswestry腰背、下肢功能障碍评分标准问卷调查及影像学随访观察。结果平均随访20个月，所有患者临床症状均在手术后得到不同程度缓解，椎间植骨融合良好，患者总体满意率为83．3％。结论复发性腰椎间盘突出症合并腰椎不稳经扩大椎管减压、椎间植骨、椎弓根螺钉固定治疗后效果较为满意。     

后路腰椎椎体间融合术治疗腰椎布鲁杆菌性脊柱炎的疗效分析

目的 探讨后路腰椎椎体间融合(PLIF)手术治疗腰椎单节段布鲁杆菌性脊柱炎的手术疗效。方法 收集新疆维吾尔自治区胸科医院2010年1月至2015年1月收治并采用PLIF手术治疗的单运动节段受累的腰椎布鲁杆菌性脊柱炎67例患者的临床资料。其中,男49例,女18例;平均年龄(49.9±13.0)岁。患者术前Frankel分级E级24例、D级24例、C级1例。患者均在全麻下行经后路椎弓根螺钉固定、单侧椎板切除开窗病灶清除自体骨粒椎间植骨融合术。术后对患者进行随访,评估疼痛视觉模拟评分(visual analogue scale score,VAS)及Frankel分级;对患者进行血红细胞沉降率(ESR)、C-反应蛋白(CRP)、布鲁杆菌血清凝集试验、腰椎正侧位X线摄影及 CT扫描复查,评定术后植骨愈合情况。结果 67例患者术后病理证实均为布鲁杆菌感染。患者平均手术时间为(101±23)min,平均失血量为 (95.22±56.87)ml。术中未出现脊髓、神经及血管损伤;术后3~7d行腰椎正侧位X线摄影复查,显示内固定均无松动,植骨位置均良好;术后有3例患者出现脑脊液漏,经过2周相应的治疗后治愈。患者术后随访9~24个月,末次随访时未见内固定松动,未发生断钉、断棒。所有患者均未见复发,未见切口延迟愈合及窦道形成。术前及术后1、3、6、12个月VAS评分分别为(7.16±0.91)、(4.19±0.92)、(3.06±0.92)、(1.48±0.59)及0分;术后各时间点VAS评分均较术前有明显改善,差异有统计学意义(F=355.95,P<0.01)。术后6个月复查ESR和CRP均恢复正常;术后9个月时行布鲁杆菌血清凝集试验复查,均转为阴性。术后行腰椎正侧位X线摄影及CT扫描复查,显示患者植骨融合情况均良好,Bridwell骨愈合标准评定术后植骨愈合,均能达到Ⅰ级愈合。患者神经功能改善明显,1例患者Frankel分级由术前C级恢复至术后E级,24例患者由术前D级恢复至E级。结论 PLIF手术是治疗腰骶椎布鲁杆菌性脊柱炎安全、有效的方法。     

Estimating lumbar bone mineral density from routine radiographs of the lumbar spine

Summary To evaluate the information content of lateral lumbar films with respect to bone mineral content, we compared reading criteria with values obtained by quantitative computed tomography (CT) of L1 at baseline and after 5 years. The highest correlations with mineral content were found for the criteria overall assessment of the vertebra, vertebral body density versus soft tissue, and amount of trabeculations. These three reading criteria yielded higher correlations with CT scores in subjects with lower body mass index. Changes in mineral content over the 5-year period could not be read adequately, the average difference representing only a loss of about 10% in the study subjects. We conclude that a rough estimate of bone density can be obtained from lateral radiographs which, in the presence of eventual risk factors for osteoporosis, may serve as an additional indication to timely bone densitometry with methods which allow precise short-term follow-up measurements.     

Herniated lumbar intervertebral disk

Low back pain is common, but a herniated intervertebral disk is the cause in only a small percentage of cases. Most symptomatic disk herniations result in clinical manifestations (pain, reflex loss, muscle weakness) that resolve with conservative therapy, and only 5% to 10% of patients require surgery. Sciatica is usually the first clue to disk herniation, but sciatica may be mimicked by other disorders that cause radiating pain. Because more than 95% of lumbar disk herniations occur at the L4-5 or L5-S1 levels, the physical examination should focus on abnormalities of the L5 and S1 nerve roots. Plain radiography is not useful in diagnosing disk herniation, but more sophisticated imaging (myelography, computed tomography, or magnetic resonance imaging) should generally be delayed until a patient is clearly a surgical candidate. Conservative therapy includes nonsteroidal anti-inflammatory drugs, brief bed rest (often for less than 1 week), early progressive ambulation, and reassurance about a favorable prognosis. Muscle relaxants and narcotic analgesics have a limited role, and their use should be strictly time-limited. Conventional traction and corsets are probably ineffective. Except for patients with the cauda equina syndrome, surgery is generally appropriate only when there is a combination of definite disk herniation shown by imaging, a corresponding syndrome of sciatic pain, a corresponding neurologic deficit, and a failure to respond to 6 weeks of conservative therapy.