CT引导下经皮穿刺盘内联合神经根周围注射臭氧治疗腰椎间盘突出症

目的 探讨CT引导下经皮穿刺盘内联合神经根周围注射臭氧治疗腰椎间盘突出症的效果.方法 对125例148个椎间盘,在CT引导下经皮穿刺达病变的椎间盘内,缓慢注射浓度为60 μg/ml的臭氧气体15～20 ml;退针至神经根附近,缓慢注射浓度为40μg/ml的臭氧气体5～10ml.结果 本组125例148个椎间盘CT引导下穿刺成功率100%.术后随访3～12个月,优102例,良12例,差11例,优良率为91.2%(114/125),所有患者均未发生椎间盘感染及脊髓、神经根、大血管损伤.结论 CT引导下经皮穿刺盘内联合神经根周围注射臭氧治疗腰椎间盘突出症是一种有效、安全的微创方法.     

CT引导下臭氧髓核消融术联合超声电导仪治疗腰椎间盘突出症的临床观察

目的 分析CT引导下臭氧髓核消融术联合超声电导仪治疗腰椎间盘突出症的临床疗效.方法 臭氧注射治疗腰椎间盘突出症136例.在CT引导下经皮腰椎间盘内注射浓度为60μg/ml的氧气-臭氧混合气体10ml/次,术后联合超声电导仪局部用药.结果 按MacNab法评定标准,术后随访4～6个月和7个月至2年有效率分别为90.4%(123/136)和93.4%(127/136),高于术后1周有效率66.2%(90/136)和2周至1个月有效率70.6%(96/136),差异有统计学意义(P<0.01).术后2～3个月有效率79.4%(108/136),与7个月至2年有效率相比,差异有统计学意义(P<0.01).术后48例患者经CT复查,18例突出消失,22例突出缩小或/和CT值较前降低,8例无明显改变.结论 CT引导下臭氧髓核消融术联合超声电导仪治疗腰椎间盘突出症方法简单,疗效确切,并发症少.疗效评价以术后4个月为宜.     

臭氧注射治疗腰椎间盘突出症的临床观察

目的 探讨CT定位下臭氧注射治疗腰椎间盘突出症的临床效果.方法 68例腰椎间盘突出症患者,共87个间隙,于CT定位下穿刺行腰椎间盘内及椎间孔周围臭氧注射术.结果 术后经3-18个月门诊及电话随访,显效49例(72.1%),有效13例(19.1%),无效6例(8.8%).总有效率91.2%(62/68),无副损伤及严重不良反应.结论 CT定位下臭氧注射治疗腰椎间盘突 出症方法简便,疗效显著,无副损伤,为治疗腰椎间盘突出症的理想方法.     

CT引导下臭氧联合硬膜外置管治疗椎间盘突出的临床应用

目的 探讨CT引导下臭氧联合硬膜外置管治疗椎间盘突出的临床疗效。方法 选择43例临床有明确腰背痛及坐骨神经性疼痛经CT确诊为椎间盘突出的患者,采用臭氧联合硬膜外置管注射治疗椎间盘突出。应用视觉评分法(visual analogue scale,AS),于术前、术后1个月、术后3个月进行评分,对治疗后1个月与3个月时的疗效进行比较。结果 术后1个月及3个月VAS评分与术前对比,均有显著差异;1个月与3个月之间,无论VAS评分以及治疗有效率的比较均无显著性差异。结论 CT引导下臭氧联合硬膜外置管注射治疗腰椎间盘突出疗效确切,具有安全性高、不良反应少等优点,值得临床推广。     

CT介入注射臭氧、胶原酶治疗腰椎间盘突出症疗效分析

目的:评价CT介入导向下臭氧、胶原酶治疗腰椎间盘突出症的临床疗效方法:对54例腰椎间盘突出症患者在CT引导下行臭氧盘内置管注射(29例)和臭氧盘内注射联合胶原酶椎管内置管注射治疗(25例),术后3个月随访时疗效进行评定结果:54例59个椎间盘均注射成功术后3个月随访,单纯臭氧组和臭氧联合胶原酶组显效、有效、无效、有效率分别为11例、15例、3例、89.7％和18例、6例、1例、96％,所有病例总体有效率92.6％,术中、术后均未出现不良反应.结论:CT介入引导向下注射臭氧、胶原酶治疗腰椎间盘突出症安全性高、定位准确、副反应少、疗效显著,具有较高的临床应用价值.     

精确化学溶核术的疗效与术后CT影像变化研究

目的探讨精确化学溶核术对腰椎间盘突出症的疗效和溶核后突出物的CT影像变化。方法回顾性分析153例腰椎间盘突出症(LDH),经CT引导下穿刺突出物,注射1200 U胶原酶进行化学溶核,分别在术后1,2,3,6,9,12月或更长时间复查CT,监测突出物变化情况,并在术后1年时评价其疗效。结果溶核后椎间盘突出物首先为密度减低,然后逐步缩小或消失。132例(86.3%)表现为突出物缩小50%以上或消失的时间在术后1~3个月,6个月以后突出物形态已经比较固定。术后1年时评估疗效,优良率92.8%,疗效差7.2%。结论精确化学溶核术治疗腰椎间盘突出症是安全和有效的,对非包容性突出病例的疗效好于包容性突出者。椎间盘突出物在精确化学溶核术后1~3月明显缩小或消失。     

骶管硬膜外造影及松解术对腰椎间盘突出症的临床应用

目的研究椎间盘突出症离子型造影剂经骶管硬膜外造影的X线征象,并探讨药物松解术对腰椎间盘突出症的临床治疗价值。方法通过对45例腰椎间盘突出症进行骶管硬膜外造影及CT对照,分析骶管硬膜外造影的X线特点,并在此基础上,将含有营养神经、消炎止痛、剥离粘连等药物的适量液体注入硬膜外腔施行松解术。结果45例均有不同程度腰椎间盘突出或膨出,诊断符合率100%。其中L2-3有6例,L3-4有15例,L4-5有36例,L5S1有33例;2个或2个以上腰椎间盘突出有12例共33个椎间盘,神经根受压63个。根据CT分型:侧突42个,中央突36个,旁侧突21个。松解术后症状缓解27例,部分缓解15例,无效3例。结论骶管硬膜外造影对腰椎间盘突出症的诊断和治疗是十分有效的,且操作简单,经济实用。     

骶管硬膜外造影及松解术对腰椎间盘突出症的临床应用

目的 研究椎间盘突出症离子型造影剂经骶管硬膜外造影的X线征象,并探讨药物松解术对腰椎间盘突出症的临床治疗价值。方法 通过对45例腰椎间盘突出症进行骶管硬膜外造影及CT对照,分析骶管硬膜外造影的X线特点,并在此基础上,将含有营养神经、消炎止痛、剥离粘连等药物的适量液体注入硬膜外腔施行松解术。结果45例均有不同程度腰椎间盘突出或膨出,诊断符合率100%。其中L2-3有6例,L3-4有15例,L4-5有36例,L5S1有33例;2个或2个以上腰椎间盘突出有12例共33个椎间盘,神经根受压63个。根据CT分型：侧突42个,中央突36个,旁侧突21个。松解术后症状缓解27例,部分缓解15例,无效3例。结论 骶管硬膜外造影对腰椎间盘突出症的诊断和治疗是十分有效的,且操作简单,经济实用。     

腰椎牵引、超短波、得宝松治疗腰椎间盘突出症疗效分析

目的评价腰椎牵引、超短波、配合硬膜外腔注射得保松治疗腰椎间盘突出症疗效。方法选取在门诊就诊的腰椎间盘突出症根性痛症状明显的患者66例,患者经腰椎牵引、超短波治疗2~3天后疗效不佳,再配合硬膜外腔注射得保松40mg,术后第二天再行腰椎牵引、超短波治疗,15天为一个疗程。以治疗前,疗程结束前患者VAS评分的变化,直腿抬高试验,生活、工作受影响程度作为评价指标进行评价。结果经治疗临床效果优:42例,良:14例,尚可:4例,差:6例。治疗后均未出现并发症。结论腰椎牵引、超短波配合得保松硬膜外腔注射治疗腰椎间盘突出症安全、有效。     

经皮腰椎间盘臭氧注射术168例回顾分析

目的探讨经皮腰椎间盘臭氧注射术对腰椎间盘突出症的疗效。方法回顾性分析2009年10月至2010年10月行经皮腰椎间盘臭氧髓核消融术治疗的168例腰椎间盘突出症患者的临床资料。按照是否符合手术绝对适应证和相对适应证情况分为A、B两组。观察两组术前及术后1周、3个月、6个月随访情况,根据视觉模拟评分(VAS)、日本骨科协会(JOA)评分、改良Macnab法进行疗效评定。结果最终A组46例、B组43例完成随访。两组术后1周、3个月、6个月VAS、JOA评分均较术前明显改善(P＜0.01);术后6个月,A组和B组治疗有效率分别为91.3％(42/46)、81.4％( 35/43),差异有统计学意义(P＜0.01)。结论经皮腰椎间盘臭氧注射术可有效缓解腰椎间盘突出症患者的腰腿疼痛,提高患者生活质量。     

硬膜外腔置管注药治疗带状疱疹后遗神经痛的护理

目的 探索硬膜外腔置管后注药治疗带状疱疹后遗神经痛患者的护理要点.方法 中重度带状疱疹后遗神经痛患者23例,采用硬膜外腔置管注药2周,观察患者置管前后体位配合、置管后导管的护理、并发症处理,术后1周及2周VAS评分,术后随访3～6月.结果 治疗后经专科护理1周,带状疱疹后遗神经痛患者疼痛程度明显减轻,治疗后1周VAS评分由6～7分下降至3～4分,2周后对疼痛进行VAS评分由3～4分下降至1～2分.结论 常规保护神经用药配合硬膜外腔置管注药治疗带状疱疹后遗神经痛患者,结合疼痛科的专科护理,达到保护神经、缓解疼痛的目的 .     

Caudal epidural injection in the management of lumbosacral nerve pain syndromes]

The effect of epidural steroid injections was assessed in 39 patients with lumbar nerve root compression syndromes in a double-blind controlled trial, the patients were allocated at random to 3 groups. In group A (n = 13) the patients received a caudal epidural injection of 1 ml (7 mg) bethametason (Diprophos) in 10 ml normal saline and 20 ml local anesthetic (Lignocaine 1%). The second group B (n = 13) received a caudal epidural injection of 20 ml local anaesthetic (Lignocaine 1%) and 10 ml normal saline. The third group C (n = 13) received a superficial injection of 1 ml (7 mg) bethametason around of the sacral hiatus. All injections were performed by the same experienced anaesthesiologist. An independent physician, who was not aware which type of injection had been given, carried out the clinical measurements and the evaluation. Taking of analgesic drug Tramadol was permitted. The symptoms were assessed by visual analogue scale (VAS 100 mm), lumbar flexion (Schober and finger-floor distance), the angle of raised leg sign (RLS degrees), and by complete neurological examination, the investigation was made 5 times (1 hour, 24 hours, 48 hours, 1 week, and 4 weeks after epidural injections). The results between 0-1 week and 0-4 week were statistically analysed by Student-, Wilcoxon-, and Mann-Whitney test and analysis of variance (ANOVA). The mean VAS values decreased in time in all patient groups. There was no difference between the three treatment groups either after one or after 4 weeks by ANOVA. The mobility of the lumbar spine improved in all patient groups, but there was no significant difference between the three treatment groups. The raised led sign--values improved in all patient groups. There was a significant difference between the three treatment groups by ANOVA after one week, due to the difference between group A and C. After four weeks there was no significant difference. No major complications or side effects were seen in our trial. The raised leg sign due to epidural steroid injection showed better results in comparison to steroid injection around of the sacral hiatus were seen.     

矫形鞋垫加医学运动训练治疗足底筋膜炎30例疗效

目的 研究穿戴定制国际生物力学学院(International College of Biomechanics, ICB)矫形鞋垫结合医学运动康复训练的治疗方式对低足弓相关性足底筋膜炎患者的中短期疗效, 探讨该康复治疗手段的价值。
方法 选取诊断为低足弓相关性足底筋膜炎的60例患者, 随机分为观察组(30例)和对照组(30例), 两组均接受常规医学运动康复训练治疗, 观察组在此基础上穿戴定制的矫形鞋垫进行介入治疗。对两组患者治疗前、治疗后1个月、6个月、12个月进行疼痛视觉模拟量表(visual analogue scale, VAS)和足踝功能量表(foot and ankle ability measure, FAAM)评分进行测量, FAAM评分由日常生活活动(activities of daily living, ADL)分量表评分和运动功能(motor ability)分量表评分组成。
结果 两组患者治疗前的VAS及FAAM各项评分(包括ADL分量表评分和运动功能分量表评分)差异均无统计学意义(P>0.05)。两组患者治疗后1个月、6个月、12个月的VAS评分及FAAM各项评分(包括ADL分量表评分和运动功能分量表评分)与治疗前比较均有改善, 差异有统计学意义(P < 0.01)。治疗后6个月、12个月, 观察组的疼痛视觉模拟评分(VAS)优于同时间点的对照组(P < 0.01);治疗后1个月、6个月、12个月, 观察组FAAM各项评分(包括ADL分量表评分和运动功能分量表评分)均优于同时间点的对照组(P < 0.01)。
结论 ICB矫形鞋垫能纠正下肢足底压力改变, 调整足弓生物力学; 在医学运动康复训练的基础上运用该疗法, 相比传统医学运动康复训练, 对低足弓相关性足底筋膜炎有更佳的中短期疗效。
     

可行走分娩镇痛临床研究

目的:探讨腰麻—硬膜外联合阻滞(CSEA)下罗哌卡因和布比卡因用于分娩镇痛的效果及对产程、母婴的影响。方法:R在蛛网膜下腔隙注入罗哌卡因3 mg和B布比卡因3 mg;然后PCEA用0.125%布比卡因+芬太尼0.125%罗哌卡因(R组)或0.125%布比卡因(B组)加芬太尼2μg/m l,持续给药(8~10 m l/h)。同期未接受PCEA分娩镇痛自然顺产的90例初产妇为对照组。用视觉模拟评分(VAS)和下肢运动神经阻滞评分(MBS)评估镇痛阻滞效果。结果:麻醉后15 m in观察组产妇VAS、MBS镇痛前后相比有显著差异P<0.01。观察组活跃期时间短于对照组P<0.01。观察组第2产程时间与对照组相比无显著性差异P>0.05。结论:CSEA罗哌卡因用于分娩镇痛较布比卡因对运动神经阻滞轻,不影响产程及新生儿。     

膝关节镜术后关节腔内联合用药对患者术后疼痛及关节肿胀的影响

目的研究关节镜术后关节腔内联合用药对患者术后疼痛、关节积液的影响。方法 80例患者分为两组:A组:术后关节腔内注射0.5%罗哌卡因2ml+玻璃酸钠2.5ml+得宝松1ml,B组:术后关节腔内注射0.5%罗哌卡因2ml。记录术后第4、8、12、24、36、48h患者屈膝90度的视觉模拟评分(VAS)和不良反应,并评价膝关节腔积液情况(浮髌实验)。结果在4、8h,各组VAS评分相当;在12、24、36、48h,A组VAS评分小于B组;两组均无不良反应发生。A组关节浮髌实验阳性率较B组明显低。结论膝关节镜手术后,关节腔内注入罗哌卡因75mg+玻璃酸钠2.5ml+得宝松1ml,在有效镇痛的同时可明显缓解患者术后疼痛,并可减轻关节腔的渗出,利于早期的功能康复。     

颈椎后路单开门椎管成形并神经根管扩大治疗脊髓型颈椎病的效果观察

目的观察颈椎后路单开门椎管成形并神经根管扩大治疗脊髓型颈椎病的临床效果。方法将60例脊髓型颈椎病患者随机分为对照组(n=30)和实验组(n=30),对照组采用颈椎后路单开门椎管成形术治疗,实验组采用颈椎后路单开门椎管成形并神经根管扩大治疗。比较两组的临床疗效、手术前后疼痛程度及术后并发症情况。结果 60例患者手术全部顺利完成,实验组的治疗总有效率高于对照组,术后并发症发生率低于对照组(P均<0.05)。实验组术后1周、 1个月及3个月的VAS评分均低于对照组(P <0.05)。结论颈椎后路单开门椎管成形并神经根管扩大治疗脊髓型颈椎病患者的临床疗效显著,可有效改善患者的脊髓神经功能,减轻术后疼痛,降低并发症发生率,值得临床推广应用。     

Treatment of patients with herpes zoster by epidural injection of steroids and local anaesthetics: less pain after 1 month, but no effect on long-term postherpetic neuralgia--a randomised trial

OBJECTIVE: To assess the effectiveness of a single epidural injection of steroids and local anaesthetics, as a supplement to the standard treatment, for the prevention ofpostherpetic neuralgia in older patients with herpes zoster. DESIGN: Open randomised trial. METHOD: In the period September 2001-February 2004, 598 patients, aged > 50 years, with acute herpes zoster (rash for < 7 days) below dermatome C6, were randomly assigned to receive either standard therapy (oral antiviral agents and analgesics) alone or standard therapy plus an additional single epidural injection of 80 mg methylprednisolone and 10 mg bupivacaine. The primary endpoint was the proportion of patients with zoster-associated pain one month after inclusion. The presence and severity of zoster-associated pain at other time points were secondary endpoints. RESULTS: At one month, pain was reported by 137 (48%) patients in the injection group versus 164 (58%) in the control group (relative risk; RR: 0.83; 95% CI: 0.71-0.97; p = 0.02). After three months, these values were 58 (21%) and 63 (24%), respectively (RR: 0.89; 95% CI: 0.65-1-21; p = 0.47), and at 6 months: 39 (15%) and 44 (17%) (RR: 0.85; 95% CI: 0.57-1-13; p = 0.43). No subgroups were detectable in which the relative risk for pain at one month after inclusion substantially differed from the overall estimate. At one month, the median severity of pain in the injection group was 2 (on a 100-points scale) versus 6 in the control group (p = 0.02). At later follow-up, there was no longer any statistically significant difference in the severity of pain between the two groups. No patient had major adverse events related to the epidural injection. CONCLUSION: A single epidural injection of steroids and local anaesthetics in the acute phase of herpes zoster resulted in a modest decrease in zoster-associated pain in the first month. This treatment did not, however, prevent long-term postherpetic neuralgia.     

骨质疏松性骨折椎体成形术后再骨折的临床治疗

目的 探讨骨质疏松性骨折椎体成形术后再骨折的治疗方法.方法 选取2010年1月至2011年1月收治的骨质疏松性骨折患者120例（140个椎体）,将术后12个月内再次骨折的15例（20个椎体）患者作为研究对象,其中11例给予骨水泥强化治疗,术后抗感染,恢复期给予积极的康复锻炼指导;4例给予抗骨质疏松治疗.随访10个月,观察有无骨水泥外漏及抗骨质疏松的治疗恢复情况.结果 11例再次骨折的患者在注射骨水泥过程中均无椎前静脉渗漏及椎间盘渗漏,术后所有患者均未出现骨水泥渗漏,其中3例注射后出现背部疼痛,主要考虑为手术影响到局部神经功能,给予镇痛药治疗后疼痛明显减轻;4例抗骨质疏松治疗恢复可,无疼痛和不适症状发生.术后3d所有患者均可下床活动,均于术后1周内出院.所有患者均未出现充填剂不良性宿主反应,无再次骨折发生.通过疼痛视觉模拟量表（VAS）进行评分,治疗后3d和终末期随访时VAS评分均明显低于治疗前[（3.05±0.55）,（0.05±0.15）分比（6.95±0.65）分],且终末期随访时VAS评分低于治疗后3d,差异均有统计学意义（P＜0.05）.结论 骨水泥强化治疗辅以抗感染及康复锻炼指导及抗骨质疏松治疗对骨质疏松性骨折椎体成形术后再骨折的临床疗效确切,安全可靠,值得临床推广应用.     

Impact of low frequency transcutaneous electrical nerve stimulation on symptomatic diabetic neuropathy using the new Salutaris device

In a double blind, randomised study, 19 patients suffering from mild-to-moderate symptomatic diabetic neuropathy (Total Symptom Score, NTSS 4-16) received either treatment with the new transcutaneous electrical nerve stimulation (TENS) device "Salutaris" (verum group) or a placebo treatment with an identical but electrically inactive device (placebo group). Stimulation pads were placed at the anatomical localisation of the peroneal nerve and stimulation was performed using a low frequency mode. At baseline (V1), after 6 (V2), and 12 (V3) wk of treatment, the patients' symptoms were registered using the new total symptom score (NTSS-6) and a visual analogue scale (VAS). In addition, sensory nerve thresholds (temperature, vibration, pain) and microvascular function were measured at the lower limb at baseline and after 12 wk of treatment. Active TENS-treatment resulted in a significant improvement in NTSS-6 score after 6 wk (-42%) and after 12 wk (-32%) of treatment (baseline: 10.0+/-3.3, 6 wk: 5.8+/-5.0, p<0.05; 12 wk: 6.8+/-3.9, p=0.05; placebo group: baseline: 7.6+/-3.1; 6 wk: 8.1+/-5.1, n.s.; 12 wk: 6.5+/-6.1, n.s.). Subanalysis of the different qualities of the NTSS-score revealed an improvement in numbness (2.2+/-1.0 to 1.6+/-1.3; p<0.03); lancinating pain (1.6+/-1.1 to 0.6+/-0.9; p<0.02) and allodynia (1.4+/-1.6 to 0.5+/-1.0; p<0.05). Also, a significant improvement in the VAS rating was found after 6 wk of TENS therapy (19.8+/-5.0 to 14.4+/-9.6; p<0.05), while no change was observed in the placebo arm. In conclusion, our study indicates that the new TENS device "Salutaris" is a convenient, non-pharmacological option for primary or adjuvant treatment of painful diabetic neuropathy.     

一次性根管治疗与多次根管治疗对牙槽骨骨密度的影响

目的 探讨一次性根管治疗与多次根管治疗对牙槽骨骨密度的影响.方法 选择2015年1月至2018年12月收治的64例根尖周炎患者,随机分为观察组和对照组各32例.观察组采用一次性根管治疗,对照组采用多次根管治疗.比较两组患者的根管填充效果、疼痛情况、复诊情况、疗效及治疗后根尖病损处牙槽骨骨密度.结果 两组的欠充率、超充率...