Automated percutaneous lumbar diskectomy

The use of automated percutaneous lumbar diskectomy for the treatment of herniated lumbar disks is increasing. More than 3000 physicians have been trained to perform the procedure, and over 40,000 cases have been completed worldwide. This review describes the development of automated percutaneous lumbar diskectomy, the selection of appropriate patients, how the technique is performed, and its efficacy relative to other methods of treatment.     

经皮穿刺腰椎间盘切割术损伤状态的脊柱稳定性研究

自的 通过对模拟椎间盘损伤状态的脊柱稳定性研究,从生物力学角度来评价经皮穿刺腰椎间盘切割术。方法 采用新鲜人体脊柱腰骶段标本。按不同的正常脊柱标本和模拟经皮穿刺腰椎间盘切割术脊柱标本,分步进行加载,分别测定两坐标系间相对位移和转角。结果 绘制载荷-转角位移曲线,计算平均柔度系数和标化的平均柔度系数,发现椎间盘损伤状态下脊柱的抗扭能力明显下降(P<0.05)。结论 从生物力学角度而言,经皮穿刺腰椎间盘切割术是一种能较好保持脊柱稳定性的治疗腰椎间盘突出症的方法。     

Far-lateral disk herniation: treatment by automated percutaneous diskectomy

Automated percutaneous diskectomy has certain advantages over other surgical approaches to the treatment of far-lateral disk herniation; primarily, the procedure can be performed under local anesthesia without soft-tissue disruption. We describe four patients with far-lateral herniations who were successfully treated with the procedure.     

经皮腰椎间盘切除术联合臭氧与联合胶原酶治疗腰椎间盘突出症的对比研究

目的 比较经皮腰椎间盘切除术(PLD)联合臭氧与联合胶原酶治疗腰椎间盘突出症的近期疗效和术后不良事件.方法 以PLD联合胶原酶溶解术治疗为对照组(115例),以PLD联合臭氧消融术治疗组为观察组(108例),进行治疗前、后对照研究,纳入随访资料完整者共计223例,观察两组的近期疗效情况和术后不良事件情况.结果 观察108例优良率为85.18%(92/108),术后不良事件发生率为5.56%;对照组115例优良率为80.00%(92/115),术后不良事件发生率为13.04%;两组近期疗效的差异无统计学意义(Pearson Chi-Square值为1.038,P ＝ 0.308),两组术后不良事件的差异无统计学意义(Pearson Chi-Square值为3.661,P ＝ 0.056);PLD观察组未发生椎间盘感染.结论 两组疗效无明显差异,为保持椎间盘内长期的减压效果和减少术后不良事件的发生率,PLD联合臭氧消融术是具有互补性的有效治疗方法.     

经皮穿刺腰椎间盘切吸术治疗腰椎间盘突出症的远期疗效

目的 观察X线电视引导下经皮穿刺腰椎间盘切吸术治疗腰椎间盘突出症的远期疗效。方法 32例经CT扫描证实的腰椎间盘突出症患者，其中，膨出型29例，游离型2例，以及突出型1例，均经X线电视引导下经皮穿刺腰椎间盘切吸术治疗，术后均经随访0.5～11.0a。结果 术后1周～3个月，32例中的24例临床症状与体征得到有效控制或明显减轻，随访5～11a观察表明，症状完全消失和明显减轻者分别见于23例和6例，总有效率90.6%，预后极好和较好者均见于膨出型腰椎间盘突出症患者。结论 游离型和突出型腰椎间盘突出症的疗效均不理想，因此，术前认真选择适应证是获得理想疗效的关键性因素。     

多发性腰椎间盘突出症经皮切吸治疗的临床应用研究

自1975年Hijikata首次报道经皮椎问盘摘除术(petcuts—neous lumbar diskectomy，PLD)治疗腰椎问盘突出症取得满意效果后，许多作者对手术器槭和操作技术作了改进，使有效率和安全性得到了提高。文献报告多见于单发性腰椎间盘突出症的治疗．对多发者介绍较少。我院自2000年11～2002年11月,共对39例多发性腰椎问盘突出症施行PLD，现报告如下。     

腰椎间盘突出介入治疗中误诊病例分析

目的：本文复习了18例腰椎间盘突出误诊病例，分析其临床影像学表现及误诊原因，以便在行PLD中吸取教训，方法：经临床和CT诊断的腰椎间盘突出症18例，均因下腰背及下肢疼痛而行常规L2－L5椎间盘CT轴位平扫。扫描层厚3mm,层中3mm，5例行PLD，8例行下胸部及腰骶部MRI平扫和增强扫描。3例行骨盆CT平扫。结果：18例中，经影像学和手术病理证实，其中10例并存肿瘤，4例并存股骨头缺血性坏死，2例为椎管内蛛网膜囊肿，1例为髋关节感染，1例为椎体及间盘结核。结论：下腰背及下肢疼痛有许多病因，在行PLD前，往往不能仅凭一个腰椎间盘突出的CT诊断，就行PLD，而要进行仔细体检，正确合理地应用影像学检查，除外并存的疾病，才能行PLD，以减少漏诊和误诊。     

高原地区CT导引经皮腰椎间盘髓核切吸术的临床研究

目的：探讨高原地区CT导引经皮腰椎间盘髓核切吸术（CT-PLD）的临床应用价值。方法：对68例腰椎间盘突出症患者实施了CT-PLD。（1）术前扫描病变椎间盘，筛选病例，并研究手术方案；（2）于即时CT图像上选择最佳的穿刺层面，设计穿刺路径，记录穿刺参数，并于体表标记穿刺点；（3）按既定参数进行穿刺；（4）经CT扫描确认穿刺进入椎间盘，扩张进针路径，进行切吸；（5）术毕CT扫描，观察进针路径有无出血及椎间盘还纳情况。结果：68例共79个椎间盘均穿刺成功。经3-18个月的随访，28例症状完全消失，36例症状明显减轻且能正常工作及生活，椎间盘还纳为1-4mm，显效率为94.12%。结论：CT-PLD安全有效，并发症少，是高原地区腰椎间盘突出症的理想的治疗方法。     

经皮穿刺颈椎间盘切除术对山羊颈椎稳定性影响的实验研究

目的 探讨经皮穿刺颈椎间盘切除（ＰＣＤ）对颈椎稳定性的影响。方法 成年山羊１０只,经皮髓核切除：Ｃ３￣４７只,Ｃ４￣５３只。术前及术后均作颈椎矢、冠、轴位ＭＲＩ及摄正侧位Ｘ线片,并分别测量手术椎间盘的高度及其相邻椎体的成角及位移情况。对以上术前与术后的测量数据,运用统计学检验方法进行ｔ检验。结果 ＰＣＤ术后,７例（７０％）手术部位椎间隙明显变窄;５例（５０％）出现骨质增生,４例（４０％）椎间盘膨出     

经皮颈椎间盘切吸术前入路的应用解剖研究

目的 明确经皮颈椎间盘切吸术（ＰＣＤ）前入路的解剖层次及相应重要结构，探讨避免损伤重要结构的方法，提高ＰＣＤ安全性及成功率。方法 ８具成人尸体，按ＰＣＤ前入路逐层解剖，观察通过的解剖层次及相应结构，并以数字相机照像记录。结果 ＰＣＤ前入路通过颈动脉鞘与气管及食管之间的间隙，该间隙内主要为颈部筋膜及筋膜间隙，深面为椎前组织。在该间隙内穿行的主要解剖结构：Ｃ３～４水平有甲状腺上动、静脉及喉上神经，Ｃ３     

椎间盘摘除术联合椎间盘内电热疗法治疗脱出型腰椎间盘突出症的临床应用

目的 研究经皮腰椎间盘摘除术(PLD)联合椎间盘内电热疗法(IDET)治疗脱出型腰椎间盘突出症的疗效.方法 回顾性分析87例患者,其中单纯PLD组39例,联合IDET组48例,术后观察、分析两组疗效及并发症.结果术后随访1～3年,平均25个月,两组术前、术后视觉模拟评分(VAS)均有改善,联合组较单纯组明显(P<0.01).治疗有效率(按Macnab标准):PLD+IDET组为87.5%,PLD组为76.9%,两组无明显差别(P>0.01).结论 PLD联合IDET与单纯PLD治疗脱出型腰椎间盘突出症均有较好疗效,联合组术后腰腿痛缓解较单纯组明显,两组术后长期功能恢复差异不显著.IDET有助于短期内减轻术后腰腿痛.     

Percutaneous cervical diskectomy: preliminary experience

We assessed the feasibility of percutaneous treatment of a cervical herniated disc. In the lumbar region, the surgical instrument for percutaneous diskectomy passes only through the paravertebral muscles, while in the cervical region there is considerable risk of nervous, parenchymal and vascular lesions. Moreover, open surgery for cervical herniated nucleus pulposus is a well-established, low-risk procedure, with little risk of epidural fibrosis, the main complication of lumbar open surgery; a percutaneous procedure should there fore have a low morbidity rate. A safe percutaneous approach to cervical dises could be useful for biopsy and for treatment of high-risk patients for general anaesthesia. We treated 15 patients with cervical herniated nucleus pulposus; all gave informed consent and refused or were not eligible for open surgery. We use the Nucleotome® described for treatment of lumbar herniated discs; except for the first three cases, we used colour Doppler sonography to detect hazardous structures in the path of the probe. We had one complication, a cervical haematoma due to damage to the inferior thyroid artery, prior to the use of ultrasound.     

MR imaging of subchondral osteonecrosis of the vertebral body after percutaneous laser diskectomy.

OBJECTIVE: We describe four cases of subchondral osteonecrosis of the vertebral body that occurred after percutaneous laser diskectomy. Follow-up MR imaging after laser intervention showed abnormal findings in the vertebral body immediately adjacent to the site of diskectomy that are consistent with subchondral osteonecrosis. CONCLUSION: MR imaging features of this complication include a wedge-shaped low signal intensity on T1-weighted images, high and low signal intensities on T2-weighted images, and a contrast-enhanced area corresponding to high signal intensity on T2-weighted images. Possible causative mechanisms include thermal injury and photoacoustic shock.     

联合应用髓核切吸与胶原酶盘内注射术治疗腰椎间盘突出症

目的：探讨提高经皮穿刺腰椎间盘髓核切吸术疗效的有效途径,方法：对50例腰椎间盘突出症病人行经皮穿刺腰椎间盘髓核切吸术后再注射胶原酶于椎间盘内。结果：有48例患者术后均获得满意疗效,其中包括10例有部分髓核组织脱入椎管的病人。结论：经皮穿刺腰椎间盘髓核切吸术后再注入胶原酶能明显提高疗效。对于突出程度较重的病人联合应用髓核切吸与胶原酶盘内注射术是一种有效的治疗方法。     

Preliminary colon cleansing for small-bowel examinations: results and implications of a prospective survey

The findings in 133 consecutive patients having a small-bowel barium follow-through examination are presented. Two conclusions are drawn: colon cleansing does not decrease transit time to the caecum and colon cleansing does not affect the examination quality.     

肾后段双下腔静脉畸形伴门静脉主干狭窄1例报告

患者　男 ,16岁。 10年前因门静脉高压 ,脾功能亢进 ,巨脾 ,ＩＴＰ而行全脾切除术。 4年前又出现呕血 ,诊断为门静脉高压 ,行肠系膜上静脉与下腔静脉“Ｈ”型搭桥手术 ,植入一直径5ｍｍ人造血管。术后门脉测压下降 12ｍｍＨｇ ,呕血停止。最近2周又开始出现呕血 ,准备再次手术而来我科行血管造影 ,以明确分流口狭窄情况。造影检查 :常规Ｓｅｌｄｉｎｇｅｒ’ｓ氏法行右股动脉穿刺。用 5Ｆ导管行肠系膜上动脉造影 ,静脉期可见肠系膜上静脉 ,门静脉主干清楚显示 ,未见肠系膜上静脉外科干与下腔静脉分流道显影。但外科干至门静脉主干起点上 10…     

MR imaging of Ho:YAG laser diskectomy with histologic correlation

Twelve cadaveric vertebral specimens were imaged after holmium yttrium aluminum garnet (Ho:YAG) laser diskectomy to determine the usefulness of magnetic resonance (MR) imaging in evaluating treatment outcome. The Ho:YAG laser was operated at 1.0-2.0 J per pulse, 5 Hz, and 250-usec pulse width. The total energy varied between 600 and 2,700 J. Two distinct patterns emerged on MR images. Tissue ablation at higher power (1.5 and 2.0 J per pulse) produced discrete signal voids that correlated with areas of laser-induced ablation identified at gross inspection. More subtle changes, characterized by a high-signal-intensity ring, were seen in the specimens lased at 1.0 J per pulse. The latter appearance corresponded to incomplete vaporization of diskal tissue, a broader zone of minimal thermal injury, and sparing of adjacent vertebral endplates. Total mass loss did not appear to be affected by the choice of power setting (1.0 vs 1.5 J per pulse), with total laser energy held constant.     

Symptomatic epidural gas after open diskectomy: CT and MR imaging findings

We report a case of symptomatic epidural gas accumulation after open diskectomy, causing lumbar radiculopathy. Surgery had been performed in a 44-year-old man for disk extrusion; however, he was readmitted to the hospital with increased lower back pain 5 months after the operation. CT and MR studies demonstrated accumulation of gas in the lumbar epidural space compressing the dural sac and nerve root. Symptoms disappeared after surgical removal of the gas.