经椎间孔入路腰椎体间融合术治疗腰椎不稳症

目的探讨经腰椎间孔入路行腰椎椎体间植骨融合术治疗腰椎不稳症的手术适应证、技术要点及应用价值。方法自2002年2月~2005年3月,对腰椎不稳56例行腰椎后正中入路,经单侧腰椎间孔行椎体间植骨融合,腰椎后方上下椎板间、棘突间、关节突间植骨,以及相应节段椎弓根钉内固定术。结果56例手术切口均一期愈合,无神经损伤、椎间隙感染和脑脊液漏等并发症。52例经6~37个月随访,平均16个月,未发生内置物断裂、松动移位和椎间隙高度丧失,骨融合率为90·38%。依据日本JOA疗效评定标准,优29例,良16例,可3例,差4例,总优良率为86·5%。结论经腰椎间孔入路椎间植骨融合术(TLIF)治疗腰椎不稳症,不但技术操作可行,而且能明显降低因侵入椎管而带来的各种可能发生的并发症,是治疗退变性腰椎不稳症的有效手术方式。     

大剂量药物硬膜外阻滞治疗腰椎间盘突出症

本文对硬膜外阻滞治疗腰椎间盘突出症时所用药物的剂量提出讨论。在152例随访者中，Ⅰ组68例、Ⅱ组84例；药物的配制强地松龙Ⅰ组50mg、Ⅱ组125mg；利多卡因Ⅰ组5mⅡ组10ml；维生素B_1Ⅰ组100mg，Ⅱ组200mg;理多维生素B_(12)Ⅰ组500μg、Ⅱ组1000μg。每周一次，三次为一个疗程。经统计学分析Ⅱ组与Ⅰ组治愈率相比有显著差异，二次治疗率有高度显著差异。故此种治疗是一种较为有效的手段。     

日间手术模式下运用椎间孔镜精准靶向治疗L5/S1巨大型腰椎间盘突出症的治疗体会

目的在日间手术(day surgery,DS)运行模式下,采用经皮椎间孔镜技术进行精准靶向定位并摘除L₅/S₁脱出的巨大椎间盘,探讨其手术技巧以及临床疗效。方法回顾性分析2018年4月至2020年3月上海市第六人民医院和湖北省中医院运用经皮椎间孔镜技术治疗的121例L₅/S₁巨大椎间盘脱出病人的临床资料,其中男82例,女39例,年龄为16~65岁,平均41.2岁。记录术中透视次数、建立通道时间以及手术时间,统计术前、术后3、6、12个月及末次随访的疼痛视觉模拟量表(visual analogue scale,VAS)评分以及Oswestry功能障碍指数(Oswestry disability index,ODI)。采用改良MacNab评分评价优良率。结果病人术中X线透视次数为8~15次,平均为10次;自穿刺开始至通道建立所用的时间为5~10 min,平均7.3 min;放置椎间孔镜后至手术操作结束的时间为15~45 min,平均为26.4 min。VAS评分从术前的(8.42±1.33)分降至末次随访的(0.95±0.54)分,ODI指数从术前的(32.48±8.82)%降至末次随访的(8.43±0.97)%,差异均有统计学意义(P均<0.05)。末次随访时改良MacNab评分,优97例,良19例,可4例,差1例,优良率为95.87%。结论对于L₅/S₁的巨大椎间盘脱出病人,在DS模式管理下,采用局部麻醉下的精准靶向椎间孔镜技术治疗,获得了满意的临床疗效,值得在临床中进一步推广。     

外周神经阻滞在血管外科重症患者下肢手术中的应用

目的采用外周神经刺激器引导行腰丛联合坐骨神经阻滞,评价其在血管外科重症患者(ASA分级为Ⅲ、Ⅳ级)下肢手术中的临床应用价值。方法2006年4月~2007年5月,接受下肢外周神经阻滞的血管外科病人,根据ASA分级分为2组,Ⅰ、Ⅱ级为普通组(C组,n=22),作为对照,Ⅲ、Ⅳ级为重症组(S组,n=25)。2组都在神经刺激器引导下行腰丛联合坐骨神经阻滞,分析两组的麻醉效果,感觉和运动阻滞的起效时间,恢复时间,术中和术后并发症发生情况。结果组间比较,两组的麻醉效果无统计学差异(C组麻醉效果好15例,中4例,差3例;S组麻醉效果好18例,中5例,差2例;U=261.000,P=0.710)。C组68.2%(15/22)的病例,S组72.0%(18/25)的病例都可以很好地满足外科手术对麻醉的要求。组间比较,2组的感觉运动阻滞起效时间无差异(P>0.1),S组腰丛、坐骨神经的感觉和运动恢复时间长于C组(P<0.01)。C组1例术中双侧阻滞,1例术后大腿前面感觉麻木;S组1例术后腹膜后血肿。这些患者经保守治疗均痊愈出院。结论血管外科下肢手术中,ASA分级为Ⅲ、Ⅳ级的重症患者应用外周神经阻滞,可以取得和普通患者同样的麻醉效果...     

椎间孔镜微创治疗腰椎间盘突出症近期疗效观察

目的：应用经皮椎间孔镜技术微创治疗腰椎间盘突出症,观察其临床治疗效果。方法;应用经皮椎间孔镜治疗腰椎间盘突出症患者28例,康复策略采用早期功能锻炼与腰椎稳定的原则进行,手术效果按照视疼痛模拟评分（VAS）和改良MacNab标准进行评定。结果：所有患者均成功实施手术,术后随访时间3个月,腰腿痛VAS评分较术前明显改善;根据改良MacNab标准优良率89.3％。结论：经皮椎间孔镜技术是治疗腰椎间盘突出症安全、有效的微创治疗办法：采用有效的康复手段,可以最大限度的减少复发,取得最大的治疗效果。     

改良微创经椎间孔腰椎体间融合术的可行性研究

目的 探讨单侧微创经椎间孔腰椎体间融合术（minimally invasive transforaminal lumbar interbody fusion,MISTLIF）采用单侧椎弓根螺钉结合对侧经椎板关节突螺钉混合内固定治疗单节段腰椎退行性疾病术后不放置引流管的可行性.方法 回顾性分析2009年1月～2011年6月55例单节段腰椎退行性疾病的临床资料,前24例（A组）采用双侧切口行MISTLIF手术,双侧置入椎弓根螺钉,并放置引流管;后31例（B组）采用单侧切口置入单侧椎弓根螺钉和对侧经椎板关节突螺钉,不放置引流管.比较2组术中出血量等指标及引流管相关并发症发生情况.结果 A组术中出血量（92.2 ±25.1）ml,术后引流量（44.1±21.0）ml,引流管放置时间（1.1±0.2）d;B组术中出血量（56.3±22.8） ml,明显少于A组（t=5.543,P=0.000）.2组术后3天超声或MRI均未见手术部位血肿或积液.2组伤口感染、血肿压迫等并发症发生情况无统计学差异（P＞0.05）.B组术后1天腰痛视觉模拟评分（visual analogue scale,VAS）优于A组（t=2.204,P=0.032）,术后下地时间和住院时间均短于A组（t=9.368,P=0.000;t=9.541,P=0.000）.结论 单节段腰椎MIS-TLIF采用椎弓根螺钉结合经椎板关节突螺钉的双侧混合内固定术后不放置引流管是可行的.     

椎间孔镜技术在腰椎间隙感染辅助治疗中的应用

目的探讨椎间孔镜技术辅助抗生素治疗腰椎间隙感染的疗效。方法回顾性分析我科2010年11月~2017年4月28例腰椎间隙感染,观察组采用经皮椎间孔镜技术辅助抗生素治疗腰椎间隙感染15例,对照组采用抗生素及卧床保守治疗13例腰椎间隙感染,比较2组治疗前和治疗后2周、1个月、3个月、末次随访疼痛视觉模拟评分(Visual Analogue Scale,VAS),日本骨科协会(Japanese Orthopaedic Association,JOA)评分及Oswestry功能障碍指数(Oswestry Disability Index,ODI),末次随访采用改良MacNab标准评价疗效。结果观察组患者疼痛消失时间(3.6±1.3)周,明显短于对照组(7.1±0.7)周(t=-8.645,P=0.000);红细胞沉降率正常时间(4.4±1.7)周,显著短于对照组(9.8±1.1)周(t=-10.134,P=0.000);观察组C-反应蛋白转阴时间(3.6±1.3)周,显著短于对照组(8.2±0.9)周(t=-10.851,P=0.000)。观察组治疗后2周、1个月、3个月疼痛VAS评分明显低于对照组(P<0.05),2组末次随访疼痛VAS评分无统计学差异(P>0.05);ODI和JOA评分组间、时间和组间与时间的交互作用差异均有显著性(P<0.05)。28例随访12~24个月,平均13.7月,观察组和治疗组末次随访改良MacNab疗效优良率分别为93.3%(14/15)、76.9%(10/13),差异无显著性(Z=-1.270,P=0.204)。结论椎间孔镜技术辅助抗生素治疗腰椎间隙感染简便,创伤小,是一种安全有效的方法。     

自制辅助穿刺装置联合三维可视化技术在内窥镜下经椎间孔腰椎间盘切除术中的应用

目的 探讨自制辅助穿刺装置联合三维可视化技术在经皮内窥镜下经椎间孔腰椎间盘切除术（PETD）治疗腰椎间盘突出症（LDH）中的应用效果。方法 2021年1月至2022年5月,安徽医科大学附属亳州医院脊柱外科94例LDH病人接受PETD治疗,采用随机数字表法选择通道建立方法。46例采用自制辅助穿刺装置联合三维可视化技术建立通道（研究组）,48例采用传统穿刺法建立通道（对照组）,两组通道建立后采用经皮椎间孔镜（TESSYS）技术完成椎间盘切除和神经根减压。分析两组透视次数、穿刺次数、穿刺时间、一次穿刺成功数、住院天数、手术时间及末次随访时改良MacNab标准评价结果。结果 所有病人都顺利完成手术和随访,无严重并发症发生。研究组和对照组的随访时间分别为（8.9±2.1）个月、（8.7±1.8）个月,两组差异无统计学意义（t=0.622,P=0.109）。研究组的穿刺时间少于对照组［（14.1±4.3） min vs. （19.1±3.7） min］,穿刺次数少于对照组［（3.8±2.1）次 vs. （7.9±2.6）次］,透视次数少于对照组［（8.3±3.3）次 vs. （15.1±4.2）次］,手术时间少于对照组［（79.0±8.5） min vs. （89.7±13.4） min］,一次穿刺成功数多于对照组（12例 vs. 4例）,组间比较,差异均有统计学意义（P＜0.05）。两组住院天数以及末次随访时的优良率比较,差异无统计学意义（P＞0.05）。结论 采用自制辅助穿刺装置联合三维可视化技术建立通道可以明显减少穿刺次数、透视次数、穿刺时间和手术时间,一次穿刺成功率较高,手术安全且疗效满意,这种新的通道建立方法是可行的。     

硬膜外麻醉加胸内迷走神经阻滞下胸腔镜肺大疱切除12例报告

目的 探讨硬膜外麻醉加胸内迷走神经阻滞下胸腔镜肺大疱切除的可行性和安全性.方法 12例肺大疱患者,在硬膜外麻醉加胸内迷走神经阻滞下行胸腔镜肺大疱切除术. 结果 12例全部治愈.3例未留置止痛泵的患者术后第1d均感术侧胸部憋胀不适,对症处理后可明显缓解.术后均获随访,中位时间7(2～12)个月,未见一例复发,复查胸部CT显示肺膨胀良好,无肺大小疱残留.结论 在严格手术适应证的前提下,硬膜外麻醉加胸内迷走神经阻滞下行胸腔镜肺大疱切除术是安全可行的,而且具有麻醉并发症少、应激反应小、便于呼吸道管理、血流动力学稳定的优点.     

Radiographic Results of Single Level Transforaminal Lumbar Interbody Fusion in Degenerative Lumbar Spine Disease: Focusing on Changes of Segmental Lordosis in Fusion Segment

Background

To assess the radiographic results in patients who underwent transforaminal lumbar interbody fusion (TLIF), particularly the changes in segmental lordosis in the fusion segment, whole lumbar lordosis and disc height.

Methods

Twenty six cases of single-level TLIF in degenerative lumbar diseases were analyzed. The changes in segmental lordosis, whole lumbar lordosis, and disc height were evaluated before surgery, after surgery and at the final follow-up.

Results

The segmental lordosis increased significantly after surgery but decreased at the final follow-up. Compared to the preoperative values, the segmental lordosis did not change significantly at the final follow-up. Whole lumbar lordosis at the final follow-up was significantly higher than the preoperative values. The disc height was significantly higher in after surgery than before surgery (p = 0.000) and the disc height alter surgery and at the final follow-up was similar.

Conclusions

When performing TLIF, careful surgical techniques and attention are needed to restore and maintain the segmental lordosis at the fusion level.     

Sciatic Nerve Block: a New Lateral Approach

The currently available methods for local anaesthetic block of the sciatic nerve are difficult to perform. Here we describe a new and easier technique for the block. The sciatic nerve is approached from the lateral side of the thigh with the patient lying supine and is identified by simple anatomical landmarks with the help of a nerve stimulator. The technique was found to be safe and effective in over 100 cases. It can be learnt quickly and is easily remembered.     

A Simple, 10-minute Procedure for Transforaminal Injection under Ultrasonic Guidance to Effect Cervical Selective Nerve Root Block

The aim is to provide a detailed procedure of a simple and 10-minute cervical nerve root block (CNRB) under ultrasonic guidance, and to report the clinical outcomes, disorders, and complications. Records of patients who had undergone CNRB, were reviewed under ultrasonic guidance at the hospital from 2010 through 2012. The procedure is described in detail. Arm and shoulder pain was evaluated by use of the visual analogue scale (VAS). Forty-three patients agreed to undergo CNRB under ultrasonic guidance. Nerve roots from C5 to C8 were affected in 41, and these nerve roots were readily distinguished. Two of the 43 participants did not receive injections because impediments in visualizing the affected nerve root. Of the 41 who received injections, radicular pain immediately disappeared in 39, who continued to feel pain relief 1 month later. However, pain recurred in 15 patients (38%), of whom 11 underwent cervical spine surgery. The rest of 24 patients felt sustained pain relief longer than 3 months after the injection, significantly. Although one patient had recurrent radicular pain 10 months later, the pain could be controlled by medication. At the final follow-up periods, 17.2 (10–24 months), the median VAS score of the patients, 23 (0 to 71 mm), was significantly improvement (P = 0.001) in comparison to before injection 88 (range; 56–100). No complications occurred. The cervical nerve root block under ultrasonic guidance simply, safely, and efficaciously decreased radicular pain for 17.2 months in 62% patients with intolerable radicular pain.     

Comparison of Local Infiltration of Analgesia and Sciatic Nerve Block in Addition to Femoral Nerve Block for Total Knee Arthroplasty

We conducted a prospective randomized controlled trial to test the null hypothesis that there is no difference between sciatic nerve block (SNB) and local infiltration of analgesia (LIA) regarding postoperative analgesia after total knee arthroplasty (TKA), when administrated in addition to femoral nerve block (FNB). Forty-six patients scheduled for TKA were randomized into two groups: concomitant administration of FNB and SNB or FNB and LIA. Average pain scores during the first 21 days after surgery were similar in the two groups and remained at low level. There was no significant difference in the need for adjuvant analgesics, patient satisfaction level, the time to achieve rehabilitation goals, and length of hospital stay. The LIA offers a potentially safer alternative to SNB as an adjunct to FNB.     

超声引导胸椎旁神经阻滞在胸腔镜肺叶切除术中应用的临床观察研究

目的:探讨超声引导胸椎旁神经阻滞与胸段硬膜外麻醉在胸腔镜肺叶切除术患者中的应用效果。方法:选择择期行胸腔镜肺叶切除术的患者52例,随机分为两组:胸段硬膜外麻醉组(E组,n=26)和超声引导椎旁神经阻滞组(P组,n=26)。记录并比较两组患者术中液体用量,舒芬太尼累积用量,血管活性药用量,术后6、12、24、36、48、72 h六个时间点安静和深呼吸时的视觉模拟评分(VAS),拉姆齐镇静评分(RSS),术后恶心呕吐次数,不良反应发生率等。结果:(1)两组术中舒芬太尼累积用量和液体用量无明显差异,但E组麻醉时长和血管活性药应用比例大于P组,女性患者比例小于P组(P<0.05);(2)术后6 h、12 h,P组的动态VAS评分均低于E组(P<0.05);(3)所有时间点,两组的静态VAS评分差异均无统计学意义;(4)术后6 h、24 h,P组的RSS评分全部大于E组(P<0.05);(5)P组的穿刺点外渗比例小于E组,干呕比例大于E组,差异有统计学意义(P<0.05)。结论:VATS肺叶切除术后患者采用超声引导椎旁神经阻滞联合静脉自控镇痛与硬膜外镇痛效果相当,且操作简单、不良反应少。     

Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis

Background  

Transforaminal epidural injection of steroids is used to treat lumbar radicular pain. However, there are only a few well-designed randomized, controlled studies on the effectiveness of steroid injection.     

不同浓度罗比卡因腰丛联合坐骨神经阻滞用于膝关节镜手术的比较

目的观察一定剂量的罗比卡因配成不同浓度溶液用于腰丛联合坐骨神经阻滞在膝关节镜手术的麻醉效果比较.方法40例拟行单侧膝关节镜手术患者随机分为A、B两组,每组20例,均在神经刺激仪定位下行腰丛联合坐骨神经阻滞,在腰丛神经和坐骨神经处均分别注入罗比卡因150 mg.A组将150 mg罗比卡因稀释到20 ml使用,即浓度为0.75%;B组稀释到30 ml,即浓度为0.5%.观察患者感觉和运动阻滞起效时间及维持时间,以及麻醉满意程度.结果两组患者感觉阻滞维持时间差异无显著性（P＞0.05）,感觉及运动阻滞起效时间A组比B组明显缩短（P＜0.05）,而运动阻滞维持时间A组明显延长（P＜0.05）,麻醉满意度B组明显优于A组（P＜0.05）.结论A组麻醉比B组起效快,但只运动阻滞时间明显延长,且麻醉满意度较差.所以在相同剂量的情况下,用0.5%的罗比卡因比用0.75%的罗比卡因行腰丛联合坐骨神经阻滞更适合于膝关节镜手术.