Incarcerated inferior lumbar (Petit's) hernia

Petit's hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. Colonic incarceration through the inferior lumbar triangle, which causes mechanical obstructive symptoms, necessitates particular diagnostic and management strategy. We present a rare case of inferior lumbar hernia, leading to mechanical bowel obstruction, successfully treated with prosthetic mesh reinforcement repair.     

Acute esophageal necrosis: "black esophagus".

Acute esophageal necrosis (AEN) is an uncommon event. We report a case of an 84-year-old female with a giant paraesophageal hernia who presented with coffee ground emesis and on esophagogastroduodenoscopy (EGD) demonstrated findings consistent with acute esophageal necrosis and a giant paraesophageal hernia with normal-appearing gastric mucosa. She was managed conservatively with bowel rest, parenteral nutrition, and continuous intravenous proton pump inhibitor (PPI). After significant improvement in the gross appearance of her esophageal mucosa, surgery was performed to reduce her giant paraesophageal hernia. The patient's postoperative course was uneventful, and she was discharged home on postoperative day 6, tolerating a normal diet. The percutaneous endoscopic gastrostomy (PEG) tube was removed in clinic 2 months postoperatively.     

Underlay mesh repair for spontaneous lumbar hernia

INTRODUCTIONLumbar hernia is a rare condition with fewer than 300 cases reported in the literature. It arises through posterolateral abdominal wall defects, named the inferior triangle (Petit) and superior triangle (Grynfelt). It can be congenital or acquired, primary or secondary, peritoneal or extraperitoneal, reducible or complicated.PRESENTATION OF CASEWe report a 63 year old female patient who presented to our hospital with a reducible right superior lumbar hernia. She underwent repair with underlay mesh after inversion of the sac and had a smooth postoperative course.DISCUSSIONIn contrast to the classical procedure the underlay mesh modification saved us from enlarging the defect, and was quick and associated with minimal tissue injury.CONCLUSIONUnderlay mesh repair for spontaneous lumbar hernia is feasible when the defect is small.     

后路腰椎椎体间植骨融合术与经椎间孔入路腰椎椎间植骨融合术治疗腰椎退行性病变的近期疗效对比

目的比较后路腰椎椎体间植骨融合术(PLIF)与经椎间孔入路腰椎椎间植骨融合术(TLIF)治疗腰椎退行性病变的近期疗效。方法 62例于我院接受单节段手术治疗的部分腰椎退行性病变患者,其中接受PLIF手术患者34例,接受TLIF手术患者28例。比较两组手术时间、出血量、住院时间、并发症及植骨融合率。手术效果按照视觉疼痛模拟评分(visual analogue scale,VAS)、JOA评分(Japanese orthopaedic association scores,JOA)、Oswestry功能障碍指数(oswestry disability index,ODI)和改良MacNab标准进行评定。结果 PLIF组与TILF组手术时间、出血量比较差异有统计学意义(P0.01);住院时间和植骨融合率比较差异无统计学意义(P0.05)。PLIF组和TILF组并发症发生率分别为26.5%(9/34)和14.3%(4/28),TLIF组低于PILF组(P0.01)。PLIF组和TILF组患者术后随访时间为6个月。两组患者术后各随访时间点腰腿痛VAS评分、JOA评分、ODI指数较术前均明显改善(P0.01),但PILF组术后1个月内腰痛VAS评分高于TLIF组。PLIF组和TILF组患者末次随访时按改良MacNab标准评定优良率分别为91.8%和87.5%,组间比较差异无统计学意义(P0.05)。结论单节段PLIF与TILF治疗腰椎退行性病变均可取得满意的近期临床疗效,但TLIF创伤小、出血少、对脊柱稳定性破坏较少。     

应用PLIF及TLIF治疗腰椎退变性疾病的比较研究

目的评价经后路椎间融合术(posterior lumbar interbody fusion,PLIF)与经椎间孔椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗腰椎退行性疾病的疗效。方法分析2012-12-2015-06应用PLIF和TLIF治疗腰椎退行性疾病患者73例,比较两组患者的手术时间、术中出血量、术后引流量、手术并发症及椎间融合效果;比较两组病例组内及组间术前、术后6个月的腰痛VAS(Visual Analogue Score)评分、Oswestry功能障碍指数调查表(The Oswestry Disability Index,ODI)评分。结果 PLIF组手术时间、术中出血量及术后引流量均较TLIF组高;PLIF组及TLIF组腰痛VAS评分术后6个月较术前均明显改善,两组组间比较术前腰痛VAS评分无明显差异,术后6个月腰痛VAS评分PLIF组较TLIF组高,差异有统计学意义;两组术后6个月较术前ODI评分明显改善,组间比较术前及术后ODI评分无明显差异。结论两种手术方法均可以有效缓解腰椎退行性疾病的症状,TLIF在手术时间、失血量及并发症的发生上都较PLIF低,对于单侧症状患者可选择TLIF的手术方式,对于双侧压迫患者可选用PLIF技术。     

误诊为腰椎间盘突出症的椎管内肿瘤

目的：椎管内肿瘤易与腰椎间盘突出症相混淆,探讨主要探讨其鉴别要点。方法：回顾分析４１６例下腰痛病人,对初诊为腰椎间盘突出症,以后确诊为椎管内肿瘤的共６例的临床症状,体征和图像分析。结果：本组病例误诊率约为１．４４％。所有病例均有不同程度的夜间痛,症状和体征平面与影像检查平面不一致。结论;正确诊断强调病史,体验和影像学检查的三结合,对有怀疑者应给予行胸腰段的ＭＲＩ检查或脊碘造影,以排除椎管内肿瘤。     

斜外侧腰椎体间融合术初次术后邻近节段退变

[目的]评价斜外侧腰椎体间融合术(oblique lumbar interbody fusion,0LIF)治疗腰椎融合术后邻近节段退变的临床效果。[方法]回顾性分析2016年12月一2019年12月本院脊柱外科采用0LIF术治疗腰椎融合术后邻近节段退变50例患者的临床资料。[结果]50例患者均顺利完成手术,均未发生严重并发症。所有患者随访12?16个月,平均(13.74±1.63)个月。术后(12.66±3.64)周患者恢复完全负重活动。随访期间,患者术后疼痛逐步减缓,功能逐步改善。与术前相比较,末次随访时VAS和0DI评分均显著下降(P<0.05)。影像方面,与术前相比,末次随访时患者的腰椎前凸角(LL)显著增加(P<0.05),而侧凸Cobb角显著减少(P<0.05)。至末次随访时,50例患者再次手术椎间隙均达到骨性融合,椎间融合器无移位、下沉。[结论]采用0LIF治疗腰椎融合术后邻近节段退变具有较好的安全性和有效性。     

通道下经椎间孔微创腰椎融合联合经皮椎弓根内固定治疗腰椎间盘突出伴腰椎不稳

目的：探讨通道下经椎间孔微创腰椎融合（TLIF）联合经皮椎弓根内固定治疗腰椎间盘突出伴腰椎不稳的临床效果。方法对82例腰椎间盘突出伴腰椎不稳患者采用通道下微创 TLIF 联合经皮椎弓根内固定治疗。结果所有患者均获随访,时间4～36个月。患者术后腰腿痛症状均明显缓解或消失,JOA 评分术前为（8．52±1．2）分,术后末次随访时为（26．32±1．6）分,差异有统计学意义（P ＜0．05）;其中优68例,良10例,中4例。植骨融合率95．12％。结论通道下微创 TLIF 联合经皮椎弓根内固定治疗腰椎间盘突出伴腰椎不稳具有创伤小、并发症少等优点,临床疗效满意。     

单侧与双侧后路椎体间融合术治疗腰椎间盘突出伴腰椎不稳的疗效比较

目的比较单侧和双侧后路椎体间融合术(PLIF)治疗腰椎间盘突出伴腰椎不稳的临床疗效。方法手术治疗51例腰椎间盘突出伴腰椎不稳患者,其中行单侧PLIF治疗26例(单侧组),行双侧PLIF治疗25例(双侧组),比较两组的手术时间、术后并发症、临床疗效满意率和植骨融合率。结果手术时间:双侧组(168±20)min,单侧组(94±18)min;术中出血量:双侧组(750±41)ml,单侧组(450±40)ml;术后输血:双侧组7例,单侧组均未输血;以上各项两组比较差异均有统计学意义(P0.05)。术中硬膜囊撕裂:双侧组1例,单侧组无。术后神经根痛加剧:双侧组2例,单侧组1例。患者均获得随访,时间14~30个月。临床疗效优良率:双侧组为84.0%(21/25),单侧组为92.3%(24/26),差异有统计学意义(P0.05)。植骨融合率:双侧组为92.0%,单侧组为96.1%,差异无统计学意义(P0.05)。结论单侧PLIF治疗腰椎间盘突出伴腰椎不稳创伤小,并发症少,临床疗效满意率优于双侧PLIF。     

后路减压内固定融合治疗退变性腰椎侧凸

目的探讨后路减压内固定植骨融合治疗退变性腰椎侧凸的临床疗效。方法后路减压内固定植骨融合治疗19例退变性腰椎侧凸患者。手术前后进行JOA、VAS评分评估临床疗效,影像学测量比较手术前后的Cobb角、骨盆倾斜角(PT)、腰椎前凸角(LL)。结果所有患者均获得随访,时间11~23(15.7±2.2)个月。JOA评分:术前为12.2分±1.7分,术后3个月为22.7分±3.1分,末次随访为24.0分±2.8分。VAS评分:术前为8.4分±0.5分,术后3个月为1.9分±0.8分,末次随访为1.8分±0.6分。Cobb角:术前为23.9°±4.2°,术后3个月为3.1°±1.4°,末次随访为3.3°±1.1°。LL:术前为31.6°±5.9°,术后3个月为42.5°±6.6°,末次随访为44.3°±6.0°。PT:术前为21.5°±7.3°,术后3个月为18.9°±9.4°,末次随访为18.5°±7.8°。以上各项指标术后3个月与术前比较差异均有统计学意义(P0.05),末次随访与术后3个月比较差异均无统计学意义(P0.05)。结论后路减压内固定植骨融合治疗退变性腰椎侧凸可充分减压,缓解症状,重建腰椎矢状面和冠状面的序列并维持脊柱稳定。     

TLIF与PLIF治疗腰椎退行性疾病疗效的Meta分析

目的:对TLIF与PLIF治疗腰椎退行性疾病的疗效及并发症进行Meta分析.方法:检索Medline、Ovid、中国生物医学文献数据库系统(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)等数据库,检索时间至2012年5月.本研究提取的评价指标包括手术时间、手术失血量、住院时间、视觉模拟评分(visual analogue scale,VAS)、Oswestry功能残障指数(Oswestry disability index,ODI)等指标和并发症例数.应用Review Manager 5.1软件进行数据分析.结果:纳入文献9篇,其中随机对照研究1篇,队列研究8篇.共981例,TLIF组457例,PLIF组524例.两组间比较,手术失血量(P=0.002)及住院时间(P=0.02)TLIF组少于PLIF组,而优良例数(P＝0.27)、手术时间(P=0.07)、VAS评分(P＝0.61)和ODI评分(P＝0.24)两组间无差异;总并发症两组间差异显著(P＜0.0001),其中神经损伤(P=0.001)、硬膜损伤(P=0.04)TLIF组较少,而脑脊液漏(P=0.25)、螺钉松动(P=0.14)、内固定失败(P=0.86)、未融合例数(P=0.41)和感染(P=0.51)两组间无显著性差异.结论:两者临床总疗效优良率相当,但TLIF手术在手术失血量、住院时间及术后并发症方面,尤其是对神经和硬膜的损伤,较PLIF明显减少.TLIF手术是一种更安全有效地治疗腰椎退行性疾病的方法.     

两种椎体间融合术治疗老年腰椎滑脱合并腰椎管狭窄疗效比较

目的比较经椎间孔椎体间融合术(TLIF)和经后路椎体间融合术(PLIF)治疗老年腰椎滑脱合并腰椎管狭窄的效果。方法将50例合并腰椎管狭窄的退行性腰椎滑脱患者根据手术方法分为TLIF组(25例)和PLIF组(25例),分析两组的临床疗效及并发症发生率。结果两组术后12个月疼痛VAS评分均低于术前(P0.05);两组术后12个月Prolo评分均高于术前(P0.05)。术后VAS评分、并发症发生率TLIF组均低于PLIF组(P0.05),术后Prolo评分及优良率TLIF组均高于PLIF组(P0.05)。结论 TLIF治疗老年退行性腰椎滑脱合并腰椎管狭窄症的临床效果较好,并可降低术后并发症发生率。     

单侧固定椎间融合术在腰椎间盘突出症伴椎间不稳手术中应用

目的探讨单侧固定椎间融合术治疗腰椎间盘突出症伴椎间不稳的临床应用价值,报告其初步临床疗效。方法自2010-01-2013-10,使用单侧固定椎间融合术治疗腰椎间盘突出症伴椎间伴不稳36例,采用JOA评分,分析术前与术后评分及融合情况。结果术后JOA平均改善率为(85.1±8.2)%,应用t检验,P0.05,具有统计学差异。结论该术式治疗腰椎间盘突出症伴椎间不稳,具有创伤小、融合率高、术后恢复快等优点,适合临床运用。     

单侧椎弓根固定经椎间孔椎体间融合术治疗下腰椎退行性疾病

目的评价单侧椎弓根固定经椎间孔腰椎椎体间融合术(TLIF)治疗下腰椎退行性疾病的疗效。方法采用单侧TLIF术治疗41例下腰椎退行性疾病患者,均为单节段手术。观察手术时间、术中出血量及并发症情况。采用腰痛和腿痛视觉模拟评分(VAS)与Oswestry功能障碍指数(ODI)评价临床效果,并通过影像学检查对椎体间融合情况进行评价。结果 41例均获随访,时间24~59(38±6)个月。手术时间80~180(125±10)min,术中出血量100~550(310±30)ml。手术切口均一期愈合。腰痛VAS分值由术前的(6.5±2.1)分下降至末次随访时的(2.3±0.9)分(P0.01),腿痛VAS分值由术前的(7.6±2.3)分下降至末次随访时的(1.2±0.8)分(P0.01),ODI由术前的54.2±10.9下降至末次随访时的13.8±2.1(P0.01)。末次随访融合率为95%,未发现继发性脊柱侧弯、螺钉松动、断裂及Cage移位等情况。结论单侧TLIF术可有选择地治疗下腰椎退行性疾病,其疗效确切,并具有创伤小、手术时间短、出血少、并发症少等优点。     

三种腰椎前屈状态下坐位腰椎旋转手法比较研究

目的探讨三种前屈状态下坐位腰椎旋转手法对退变椎间盘的影响,从而为优化手法提供依据。方法使用正常L4-5腰椎CT片,以Mimics软件系统逐层重建,建立退变的腰椎间盘的L4-5三维有限元模型,根据手法原理,将坐位腰椎旋转手法进行分解,按A、B、C三种腰前屈角度（A=6°;B=9°;C=12°）把各项力学参数代入三维有限元模型进行计算分析。结果随着屈度的增加,旋转侧椎间盘的后外侧应力不断增加。除去C状态外,A、B两种状态的椎间盘两后外侧位移相近。C状态旋转侧后外部明显向后内侧突出。增加了该部位位移。结论从解除粘连的考虑,旋转手法时,屈度不能太大,具有使椎间盘突出的危险,向健侧旋转优于向患侧旋转。     

Timing of surgery in congenital diaphragmatic hernia

Eighty-six consecutive patients with congenital diaphragmatic hernia presenting within 6 hours of birth to a regional neonatal surgical unit were reviewed. Patients were managed under a policy of delayed surgery which has evolved during the 6-year study period. Overall survival (to leave hospital) was 70.9%. There were only seven postoperative deaths (10.3% of operations). Analysis of the 25 deaths in the light of postmortem findings and published exclusion criteria indicates that the availability of extracorporeal membrane oxygenation would have made little difference to overall survival.     

A retrospective study of epidural and intravenous steroids after percutaneous endoscopic lumbar discectomy for large lumbar disc herniation

Objective: To assess the early curative effect of epidural or intravenous administration of steroids during a percutaneous endoscopic lumbar discectomy (PELD).Methods: 28 consecutive patients who underwent PELD due to large lumbar disc herniation betweenNovember 2014 and January 2016 were followed up for 6 months. These patients were divided into twogroups according to the treatment they received after PELD. 14 patients (Group A) were treated by PELD and epidural steroids, while the other 14 patients (Group B) were treated by PELD and intravenous steroids. We evaluated the effectiveness by the preoperative and postoperative visual analogue scale (VAS) scores for back and leg pain, and the postoperative Oswestry disability index (ODI) at 3 weeks after surgery via the clinical charts and telephone interview. Postoperative hospital stay and time return to work were investigated as well.Results: There is a significant decrease in VAS (back, leg), ODI, and time return to work (p < 0.05). For VAS (back), Group A showed a significant decrease compared with Group B at 1 day and 1 week after surgery (p=0.011, p=0.017). As for VAS (leg), Group A showed a significant decrease compared with Group B at 1 day, 1 week, 3 weeks, and 3 months follow-up examinations (p=0.002, p=0.006, p < 0.001, p < 0.001). For ODI, Group A showed a notable decrease compared with Group B (p < 0.001). Thepostoperative hospital stay in two groups was not statistically different (p=0.636). But the time return to work in Group A was significantly shorter than that in Group B (p=0.023).Conclusion: Patients who underwent PELD with epidural steroid administration for large lumbar discherniation showed favorable curative effect compared with those who underwent PELD with intravenous steroid administration.