后路钉棒内固定加椎间植骨治疗腰椎不稳症75例分析

目的探讨后路椎弓根钉内固定加椎间融合术治疗退变性腰椎不稳症的效果。方法对75例退变性腰椎不稳症行后路椎体间融合和相应节段椎弓根钉内固定术。结果 75例经14~30个月随访,优良率88%。结论后路椎弓根钉内固定加椎间融合术是治疗退变性腰椎不稳症的有效手术方式。     

经皮椎弓根钉系统联合椎间盘镜下椎间融合治疗腰椎不稳症

[目的]探讨经皮椎弓根螺钉系统结合椎间盘镜下减压和椎间融合术治疗退变性腰椎不稳的初步疗效.[方法]回顾性分析采用经皮椎弓根系统加椎间盘镜下后路椎间融合术17例退变性腰椎不稳患者的临床资料.[结果]平均随访时间10(3～15)个月.按steffee标准的评估:优12例,良3例,中2例,症状改善优良率88%.术后X线片示病变椎间隙高度恢复,滑脱复位,术后3个月已有骨性融合.[结论]经皮椎弓根系统结合椎间盘镜下减压和椎间融合术治疗退变性腰椎不稳症具有创伤小、出血少、恢复快且融合可靠的优点,是一种具有前景的治疗下腰椎不稳的微创术式.     

腰椎滑脱症后路内固定植骨融合术的围手术期护理

目的探讨腰椎滑脱症患者行后路椎弓根螺钉内固定加植骨融合术的围手术期护理措施.方法我院1998年1月～2003年2月5年间对32例腰椎滑脱症患者行后路椎弓根螺钉内固定加植骨融合术治疗.通过术前术后对各种类型滑脱患者的各项护理措施进行回顾性分析总结.结果32例患者术后均获随访,随访时间5～40个月,平均16个月,经拍片或/和CT检查,植骨融合良好,融合标准[1]、疗效评定标准[2],优20例,良9例,可3例,差0例,优良率90.6%.结论腰椎滑脱症后路椎弓根螺钉内固定加植骨融合术具有早期制动减压,后期骨性融合固定,融合率高及早期下床活动的优点.提高围手术期的各项护理质量对保证手术成功,促进患者全面恢复具有至关重要的意义.     

循证护理在经后路腰椎弓根内固定加椎体间植骨融合术中的应用

目的:探讨循证护理在经后路腰椎弓根内固定加椎体间植骨融合术中的应用效果.方法:将我科收治的120例经后路腰椎弓根内固定加椎体间植骨融合术患者随机分为观察组与对照组,观察组60例应用循证护理的方法实施护理,对照组60例采用常规护理方法.观察两组术中并发症发生情况,并进行对比分析.结果:观察组术中并发症发生率明显低于对照组.结论:循证护理应用于经后路腰椎弓根内固定加椎体间植骨融合术,可减少术中并发症的发生,对患者的康复及预后有重要的临床意义.     

腰椎滑脱症后路内固定植骨融合术的围手术期护理

目的 探讨腰椎滑脱症患者行后路椎弓根螺钉内固定加植骨融合术的围手术期护理措施。方法 我院1998年1月～2003年2月5年问对32例腰椎滑脱症患者行后路椎弓根螺钉内固定加植骨融合术治疗。通过术前术后对各种类型滑脱患者的各项护理措施进行回顾性分析总结。结果 32例患者术后均获随访，随访时间5～40个月，平均16个月，经拍片或／和CT检查，植骨融合良好，融合标准、疗效评定标准，优20例，良9例，可3例，差0例，优良率90．6％。结论 腰椎滑脱症后路椎弓根螺钉内固定加植骨融舍术具有早期制动减压，后期骨性融合固定，融合率高及早期下床活动的优点。提高围手术期的各项护理质量对保证手术成功，促进患者全面恢复具有至关重要的意义。     

椎弓根螺钉内固定加后路植骨融合治疗腰椎滑脱症32例分析

目的 探讨椎弓根螺钉内固定加后路植骨融合治疗腰椎滑脱的临床价值.方法 采用椎弓根螺钉+后路植骨融合术治疗腰椎滑脱症32例,术后按Asher标准评价临床效果.结果 32例患者随访8～24个月,平均17个月.优23例,良7例,可2例.所有病例均获骨性融合.结论 椎弓根螺钉内固定加后路植骨融合具有操作简单、复位满意、融合率高、能最大限度恢复脊柱的力学结构,恢复椎间高度及椎间孔容量,腰椎滑脱症较为理想的治疗方法.     

腰椎滑脱症52例围术期护理

对52例腰椎滑脱症患者采用后路通用椎弓根螺丝棒系统行内固定加椎体间植骨融合术,并给予精心围术期护理.结果本组优37例,良11例,可4例,优良率达92.3%.认为做好腰椎滑脱症患者术前、术后护理,可有利于减少术后并发症的发生,缩短卧床及康复时间,提高优良率.     

椎弓根钉系统复位内固定椎体间植骨融合治疗腰椎滑脱症的研究

目的:探讨椎弓根钉系统复位内固定、椎体间植骨融合治疗腰椎滑脱症的疗效。方法:对28例腰椎滑脱患者行椎弓根螺钉系统复位内固定,利用减压时切下的棘突、椎板骨碎块,通过后路进行椎体间植骨融合。结果:随访12个月～30个月,平均20个月,28例患者的腰腿痛等临床症状缓解,26例患者完全复位,2例部分复位,术后4个月～6个月复查X线片,显示28例患者均获得椎体间骨性融合。结论:椎弓根螺钉系统复位内固定、椎体间植骨融合治疗腰椎滑脱症效果满意。     

腰椎间盘突出症合并腰椎不稳的手术治疗

目的探讨手术治疗腰椎间盘突出症合并腰椎不稳的疗效。方法对37例腰椎间盘突出症合并腰椎不稳患者采用后路间盘髓核摘除、椎间植骨融合或加椎板间植骨融合、椎弓根钉棒系统内固定术治疗,术后平均随访9个月。结果所有患者均达到骨性融合,临床疗效评价优28例、良7例、可2例,优良率95.6%。结论腰椎后路髓核摘除、植骨融合内固定术是治疗腰椎间盘突出症合并腰椎不稳的有效方法。     

后路单枚椎间融合器加椎弓根螺钉治疗腰椎间盘突出症并腰椎不稳

目的 评价腰椎间盘摘除联合单枚椎问融合器与椎弓根螺钉系统在治疗腰椎间盘突出症合并腰椎不稳的手术疗效.方法 对22例腰椎间盘突出症并腰椎不稳患者采用后路椎间盘摘除及神经根管减压,斜向植入单枚椎问融合器加椎弓根螺钉固定治疗.结果 22例患者随访6～23月,平均10.5个月,22例患者临床疗效评价,优15例,良5例,可2例,未见症状加重或椎间高度丢失等情况,无神经根损伤、感染等并发症.结论 腰椎间盘摘除联合单枚椎间融合器与椎弓根螺钉系统行后路椎间融合术(PLIF)是治疗腰椎问盘突出症合并腰椎不稳的有效治疗方法.     

微创经椎间孔椎体间融合术治疗腰椎间盘突出症伴腰椎不稳

目的:通过与传统开放手术进行比较,探讨微创经椎间孔椎体间融合术(mini-open transforaminal lumbar interbody fusion,mini-TLIF)治疗腰椎间盘突出症伴腰椎不稳的临床效果.方法:2011年1-10月,采用经Mast Quadrant通道下减压联合经皮椎弓根螺钉固定(Sextant)微创治疗腰椎间盘突出症伴腰椎不稳19例,传统开放手术治疗24例.比较两组手术出血量、手术前后腰腿痛VAS评分、JOA评分、腰椎前凸角(lumbar lordosis angle,LLA)及腰椎活动度(range of movement,ROM).结果:本组所有病例都得到5～ 12个月随访,平均8.9个月,其中,微创组手术出血量为50～380 mL,平均177 mL,开放组手术出血量为400～1 240 mL,平均706 mL,差异有统计学意义(P＜ 0.001);两组术后一周及末次随访时腰、腿痛VAS评分与治疗前比较均显著降低,差异有统计学意义(P＜ 0.001),术后一周及末次随访时微创组腰痛VAS评分较开放组更低(P＜ 0.001),术后1周及末次随访时两组腿痛VAS评分比较差异无统计学意义(P＞0.05),末次随访时两组JOA评分比较差异无统计学意义(P＞0.05),微创组末次随访时腰椎前凸角及腰椎活动度均大于开放组(P＜0.05).结论:经Quadrant通道下减压联合经皮椎弓根螺钉固定(Sextant)微创治疗腰椎间盘突出症伴腰椎不稳具有创伤小、手术出血少、术后疼痛轻、更好的保留腰椎曲度及活动度等特点,是一种有效的方法.     

Flexion-relaxation response to cyclic lumbar flexion

BACKGROUND: The epidemiology classify cyclic lumbar flexion as a risk factor for the development of cumulative low back disorder. Experimental biomechanical data confirming the epidemiology in humans are lacking. The purpose of this study, therefore, is to investigate the flexion relaxation response to sustained cyclic lumbar flexion in humans. METHODS: Twelve normal college aged males performed deep cyclic lumbar flexion at 0.1 Hz for 9 min while recording lumbar paraspinal electromyogram and kinematic data. FINDINGS: The most important observation of the study was the significant increase in the angular excursion of myoelectric silence during the deep part of the flexion phase. The observed increase in myoelectric silence consisted of earlier cessation of EMG during flexion and delayed activation of trunk extensors during extension. EMG magnitude, during flexion, increased approximately 30% over trials (P < 0.0001), and a smaller (10%), but, significant (P < 0.02) EMG magnitude increase was also observed during the extension phase of the cycle. Spasms, an indication of micro damage to viscoelastic tissues, were sporadic and appeared more frequently later in the session and mostly during the silent period. INTERPRETATIONS: It was concluded that increased myoelectric silence during prolonged cyclic flexion-extension demonstrates an enhanced flexion-relaxation phenomenon which reduces lumbar stability and may be detrimental to low back health. The presence of spasms confirm that sustained cyclic lumbar flexion results in micro damage in the viscoelastic tissues. Overall, a neuromuscular disorder was evoked due to a relatively short period of unloaded cyclic lumbar flexion.     

后路Ray-TFC对腰椎稳定性的影响

目的 评价腰椎后路Ray-TFC的即时稳定性。方法采用国人成年男性新鲜脊柱标本进行离体生物力学实验，以中性区(NZ)和运动范围(ROM)为观测指标，通过生物力学实验机测定单纯Ray-TFC植入后腰椎运动节段的三维稳定性。结果 单纯Ray-TFC植入后，NZ在前屈、后伸和侧弯时明显减小，但ROM在后伸和旋转时明显增大。结论 后路Ray-TFC植入可使腰椎运动节段的即时稳定性在除旋转的所有方向上显提高，其对腰椎运动节段稳定性的影响在国人与西方人之间无显差异。     

Reliability of B-mode ultrasonography to measure lumbar multifidus muscle dimensions in patients with unilateral lumbar disc herniation

ObjectivesTo evaluate Ultrasound Imaging (USI) reliability for measurement of lumbar multifidus (LMF) muscle thickness and cross sectional area (CSA) at rest and during contraction in patients with unilateral lumbar disc herniation.SettingLaboratory.DesignReliability Study.ParticipantsThirty patients, aged 25–50 years (37.55 ± 9.55), with unilateral L4-L5 lumbar disc herniation participated in this study.Main outcome measuresThickness and CSA of LMF were measured using B-mode ultrasound by two raters in prone position.ResultsSame day and multiple day inter-rater and same day intra-rater reliability showed good to excellent reliability (intraclass correlation coefficients ranged from 0.70 to 0.91). Also standard error of measurement and minimal detectable change for USI reliabilities ranged from 0.06 to 0.57 and 0.16 to 1.31, respectively.ConclusionsReliability of USI for measurements of LMF muscle thickness and CSA was high, and consistent with previous studies conducted on reliability of USI to measure LMF dimensions in other populations.     

单独置入扩张型椎间融合器再次修复复发性腰椎间盘突出症重建腰椎稳定性

背景：椎间融合器逐渐代替传统的椎体间自体结构植骨而广泛应用于腰椎后路椎间融合治疗中,但绝大多数报道此时均需辅以椎弓根螺钉系统内固定。目的：评估复发性腰椎间盘突出再次修复过程中单独应用扩张型椎间融合器行腰椎后路椎间融合而不需使用椎弓根螺钉辅助内固定的可行性。设计、时间及地点：回顾性病例分析,2004-10/2007-01在中山大学附属第三医院骨科进行。对象：对17例复发性腰椎间盘突出症患者采用可扩张椎间融合器行腰椎后路椎间融合再手术治疗,男7例,女10例,再次手术时年龄31-68岁,平均41岁,两次手术间隔时间9个月-8年,平均3.6年。17例均有持续或间歇性腰背痛,间歇性跛行5例、下肢反射痛9例、下肢麻木7例、下肢肌力减弱11例。方法：常规后路切口,保留棘突与棘间韧带,依次行双侧椎板减压,彻底减压,松解粘连,切除残留的椎间盘组织,撑开椎间隙,用绞刀、丝锥依次平行于终板绞孔与攻丝,自两侧旋入可扩张椎间融合器,确认位置正确后,旋拧位于融合器内的扩张螺丝、直至将椎间融合器完全扩张,于椎间融合器内置入自体松质骨碎骨块,最后将端盖轻轻拧紧。主要观察指标：手术时间、术中出血量;椎间融合器置入后与宿主的组织相容性反应;随访复查影像学表现、功能恢复情况。结果：①手术时间70-200min,平均90min,术中出血100-800mL,平均150mL。②17例均获得随访,随访时间6-32个月,平均18个月。均未发现椎间融合器移位、下沉,置入后4个月均开始出现骨性融合。无一例出现感染及置入物排斥反应。③置入后即刻下肢放射痛消失,下肢麻木症状于置入后2-6个月逐渐恢复。按Macnab法疗效评定标准随访结果为：优10例,良6例,可1例,优良率为94.1%。结论：腰椎间盘突出症再次修复过程中单独应用扩张型椎间融合器可以重建脊柱正常的生理序列。     

非手术治疗腰椎间盘突出症150例两年随访对照

目的通过318例腰椎间盘突出症手术和非手术的临床效果的对比研究,探讨腰椎间盘突出症的非手术治疗方法。方法非手术治疗组150例患者采用卧硬板床休息、骨盆牵引、理疗及β-七叶皂甙钠静滴,疼痛缓解后进行腰背肌功能锻炼。对照组168例,确诊后进行手术治疗,术后1周行常规的腰背肌锻炼,平均随访2.1年。结果对照组优良率83.93%,非手术组优良率83.33%,两组χ2检验无显著性差异(P>0.05)。结论腰椎间盘突出症手术不是首选的治疗方法,有些病例可以通过非手术治疗达到治愈。     

Is Dynesys dynamic stabilization system superior to posterior lumbar fusion in the treatment of lumbar degenerative diseases?

Dynesys, a pedicle-based dynamic stabilization system, was introduced to overcome some undesirable complications of fusion procedures. Nevertheless, the theoretical advantages of Dynesys over fusion have not been clearly confirmed. The purpose of this editorial was to compare clinical and radiological outcomes of patients who underwent Dynesys system with those who underwent posterior lumbar fusion according to the existing literature and to see if the application of the Dynesys system is superior to the traditional lumbar fusion surgery. According to published clinical reports, the short-term effects of the Dynesys dynamic stabilization system are similar to that of traditional lumbar fusion surgery. Three comparative studies of Dynesys dynamic stabilization and fusion surgery with medium-term follow-up are encouraging. However, the results from four single-treatment-arm and small-sample studies of case series with long-term follow-up were not encouraging. In the present circumstances, it is not possible to conclude that the Dynesys dynamic stabilization system is superior to fusion surgery for lumbar degenerative diseases.     

Back pain secondary to Brucella spondylitis in the lumbar region

Brucellosis is a systemic, infectious disease caused by the bacterial genus Brucella and a common zoonosis that still remains a major health problem in certain parts of the world such as the Mediterranean region, the Middle East, and Latin America. It may involve multiple organs and tissues. Osteoarticular involvement is the most frequent complication of brucellosis, in which the diagnosis of brucellar spondylitis is often difficult since the clinical presentation may be obscured by many other conditions. There are only a few reports on brucellar spondylitis in Korea. Here, we report a case of spondylitis due to brucella in an elderly male.     

Flexion-relaxation response to static lumbar flexion in males and females

OBJECTIVE: To determine if creep developed in the lumbar viscoelastic tissues during a period of static flexion elicited changes in the muscular responses of the flexion-relaxation phenomenon. BACKGROUND: Static lumbar flexion is a risk factor in workers, yet the physiological biomechanical and histological processes active in the evolution of the consequent low back disorder were not demonstrated experimentally. Controlled animal studies show that static lumbar flexion develops creep in the associated viscoelastic tissues and elicits spasms and modification of muscle function. Such neuromuscular changes are to be investigated in this study while assessing normal human subjects via the flexion-relaxation phenomenon. METHODS: Male and female subject groups performed three bouts of lumbar flexion-extension before and after a 10 min period of static lumbar flexion. The surface electromyographic from the erector spinae muscles as well as flexion angle were recorded. The angle in which electromyographic diminished during flexion and initiated during extension was determined and subjected to ANOVA with repeated measures to determine any significant changes in the flexion-relaxation response. RESULTS: The erector spinae were active through a significantly larger angle during flexion and initiated activity significantly earlier during extension after static flexion. Females demonstrated more pronounced changes than males. EMG amplitude did not change significantly. Spasms were recorded in more than half of the subjects during the static flexion period. CONCLUSIONS: Creep developed during a short static lumbar flexion elicited significant changes in the muscular activity pattern of the flexion-relaxation phenomenon. The muscles seem to compensate for the loss of tension in the lumbar viscoelastic tissues, while spasms suggest that some micro-damage was incurred to the viscoelastic tissues. RELEVANCE: Static lumbar flexion is shown experimentally as an activity that constitutes an occupational risk factor for the development of low back disorder.     

腰椎间盘突出症合并腰椎不稳治疗中Quadrant系统的应用

背景：腰椎间盘突出症手术后仍有10%-30%的患者症状缓解不明显,统称为腰椎术后失败综合征,而腰椎不稳是其中的一个重要原因。目的：探讨Quadrant系统下后路腰椎管减压、椎间盘摘除、椎间融合和椎弓根螺钉固定治疗腰椎间盘突出症合并腰椎不稳可行性和有效性。方法：2011年12月至2012年10月应用Quadrant系统行后路腰椎管减压、椎间盘摘除、椎间植骨加融合器置入、椎弓根螺钉固定治疗腰椎间盘突出症合并腰椎不稳患者62例,男38例,女24例。年龄37-69岁,平均年龄为53.7岁,治疗后随访评价治疗效果。结果与结论：手术时间为90-210 min,平均时间145 min。术中失血量50-300 mL,平均失血量120 mL。治疗后住院时间5-9 d,平均住院时间6 d。手术切口均一期愈合。随访3-10个月,平均7.2个月。JOA评分治疗前为(10.25±2.34)分,治疗后1个月及末次随访时分别为(18.31±3.12)分和(25.35±2.61)分。与治疗前比较均有显著性差异(P <0.01)。目测类比评分治疗前为(8.24±1.15)分,治疗后1个月及末次随访时分别为(2.97±1.12)分和(1.13±0.39)分。与治疗前比较均有显著性差异(P <0.01)。末次随访时采用改良Macnab标准评价临床效果,优53例,良9例。证明Quadrant系统下后路腰椎管减压、椎间盘摘除、椎间融合和椎弓根螺钉固定治疗腰椎间盘突出症合并腰椎不稳,是一种安全有效的微创治疗方法。