胶原酶溶解术治疗腰椎间盘突出症78例疗效分析

目的探讨胶原酶溶解术治疗腰椎间盘突出症的临床价值。方法采用盘外穿刺术,对78例腰椎间盘突出症病例施行胶原酶溶解术。对手术后疗效进行观察分析。结果78例患者中显效56例,有效15例,无效7例,总有效率91.02%。结论盘外穿刺胶原酶溶解术治疗腰椎间盘突出症操作简便、安全、不良反应轻、疗效佳。     

几种特殊椎间盘突出胶原酶溶解术疗效观察

近年来 ,有关腰椎间盘突出症胶原酶溶解术的报道较多 ,现将我院从 1 997年以来采用胶原酶溶解术治疗腰椎间盘突出症 32 0例中有突出合并钙化手术后症状复发、多发性突出、高位突出、老年突出等 88例特殊类型病例的溶解治疗效果报告如下。材料和方法一、病例资料本组 88例中 ,腰椎间盘突出合并钙化 2 3例 ,外科手术后复发 8例 ,Ｔｈ1 2～Ｌ3高位突出 4例 ,2个以上的多发性突出 1 9例 ,外侧型突出 3例 ,60岁以上的老年性突出 31例。男 63例 ,女 2 5例 ,年龄 31～ 76岁。二、治疗方法经患侧椎间孔穿刺 ,置穿刺针于病变椎间隙后上方 ,正位在椎弓…     

臭氧联合胶原酶注射治疗脱出型腰椎间盘突出症

目的 观察臭氧联合胶原酶注射治疗脱出型腰椎间盘突出症的疗效.方法 臭氧盘内消融术、胶原酶盘外溶解术联合应用治疗脱出型腰椎间盘突出症.结果 治疗脱出型腰椎间盘突出症41例,共治疗50个椎间盘,采用Macnab疗效评价标准评价,优良率85.3%,术后12个月影像复查(CT、MRI)与术前对照显示AB值、R值术后是术前的36%、43%,有较为明显的缩小.结论 本项技术治疗脱出型腰椎间盘突出症疗效肯定,胶原酶对纤维环有溶解作用,臭氧对髓核有氧化作用,两者结合疗效肯定,且随时间延长逐渐向好,术后1年影像检查明显变小.     

双重胶原酶溶解术治疗腰椎间盘突出症

目的　探讨双重胶原酶溶解术治疗腰椎间盘突出症的临床价值。方法　对 31例腰椎间盘突出症病例行双重胶原酶溶解术。通过 15～ 31个月的随访对其疗效进行分析。结果　 31例患者 ,显效 2 7例 ,有效 3例 ,无效 1例。总有效率 96 .7%。结论　双重胶原酶溶解术治疗腰椎间盘突出症具有疗效佳 ,适应证广 ,不良反应少的优点 ,值得临床推广     

介入法治疗腰椎间盘突出症的临床应用及其评价

目的 评价经皮穿刺椎间盘切吸术和胶原酶溶解术治疗腰椎间盘突出症的临床应用及疗效。方法 180例中男性116例,女性64例;年龄19～79岁。152例行经皮穿刺腰椎间盘切吸术;28例行经皮穿刺腰椎间盘胶原酶溶解术。结果 共切吸腰椎间盘172个,胶原酶溶解腰椎间盘36个。痊愈和显效为77％,总有效率为92％。结论 此方法操作简单、安全可靠,效果肯定,应作为保守治疗无效且有适应症的腰椎间盘突出症的首选方法。     

臭氧盘内注射术联合胶原酶盘外溶解术治疗突出型腰椎间盘突出症的多中心应用观察

目的探讨经皮穿刺臭氧盘内注射联合胶原酶盘外溶解术,治疗腰椎间盘突出症的疗效及安全性。方法按统一的选择标准[纤维环破裂、髓核突出幅度在10mm以内、压迫硬膜囊或(和)神经根的腰椎间盘突出症]、治疗方法(臭氧盘内注射联合胶原酶盘外溶解),对行臭氧盘内注射术加联合胶原酶盘外溶解术、资料完整的腰椎间盘突出症541例患者进行复诊、书信、电话等方式随访观察,随访时间和例数分别为:2～3个月(近期)541例,4～12个月(中期)312例,13～18个月(远期)115例,按统一的疗效标准评价臭氧盘内注射联合胶原酶盘外溶解术的近、中、远期疗效,并与有关多中心单纯行胶原酶盘外溶解术例疗效进行对比。结果所选病例近、中、远期有效率分别为95.9%(519/541)、90.4%(489/541)、87.2%(472/541);两种方法联合应用,突出的髓核有明显的不同程度的回缩,平均缩小30.5%;单纯行胶原酶溶解术近、中、远期有效率分别为89.5%、82.4%、80.4%。结论臭氧盘内注射联合胶原酶盘外溶解术是纤维环破裂、髓核突出幅度在10mm以内、压迫硬膜囊或(和)神经根的腰椎间盘突出症的一种高效的治疗方法,其疗效优于单纯胶原酶溶解...     

CT定位在腰椎间盘溶解术中的应用探讨

椎间盘溶解术是近年来国际上发展起来的一项新的介入疗法 ,它是借助影像的监测 ,经皮穿刺 ,局部注射生物制剂 ,溶解退变突出的纤维环和髓核组织而不影响脊柱、椎管等结构 ,以解除对神经根的压迫 ,消除症状的一种方法[1]。1　材料与方法1.1　一般材料　本院 2 0 0 1-11～ 2 0 0 3 -0 1采用CT定位下胶原酶溶解术治疗腰椎间盘突出症患者 70例 ,均经CT或MRI明确诊断为腰椎间盘突出症 ,具有典型的根性坐骨神经痛 ,腿痛比腰痛更为严重 ,下肢感觉异常 ,病程 2周以上 ,经保守治疗无效。且符合椎间盘突出物无钙化或无死骨碎片 ,无腰椎管骨性狭窄 ,…     

注射胶原酶治疗腰椎间盘突出症的临床应用

１９９４年１２月至１９９６年８月，我院主要采用盘外注射（２３０例）部分患者采用盘内注射（２０例）胶原酶治疗腰椎间盘突出症，随访２００例，优良率达９１％。介绍了注射胶原酶的操作方法及注意事项，认为：胶原酶化学溶解术疗效好、创伤小、操作简单、安全、并发症少。髓核突出大小１０ｍｍ，髓核突出伴钙化，伴侧隐窝狭窄，手术治疗复发的椎间盘突出症等，不是盘外注射胶原酶治疗的绝对禁忌证。     

X光下靶位穿刺胶原酶溶解术联合医用臭氧注射术治疗腰椎间盘突出症

目的 探讨X光下靶位穿刺胶原酶溶解术联合臭氧治疗腰椎间盘突出症的临床价值.方法 采用X光下盘内和盘外穿刺术,对1062例腰椎间盘突出症病例施行胶原酶溶解术联合臭氧治疗.对手术后疗效进行观察分析.结果 1062例患者中治疗效果达优、良者术后3个月时为95.3％,12个月时为92.3％,24个月时为91.2％.结论 X光下...     

CT导向胶原酶溶核治疗腰椎间盘突出症

胶原酶化学核溶解治疗腰椎间盘突出症是近年来发展起来的微创手术治疗椎间盘突出的新方法。在ＣＴ导向下治疗 ,方法简单有效、安全性高、越来越多地得到应用[1] 。我院自 1997年 2月～ 2 0 0 0年5月间 ,对 72例患者进行胶原酶化学核溶解治疗腰椎间盘突出。近期疗效良好 ,现总结报道如下。材料与方法一、一般资料选择病例的标准是 :经临床检查和ＣＴ扫描证实为腰椎间盘膨出或突出 ,伴有明显的根性痛症状 ,经 3个月的正规保守治疗无效者。对于伴有椎间盘钙化或椎管及侧隐窝狭窄、椎间盘脱出游离于椎管内的病例 ,不在选择之列。根据以上标准 ,…     

腰椎间盘突出症微创介入治疗后再手术时难点与对策

目的通过分析腰椎间盘突出症微创介入治疗后再手术的主要原因,其临床处理中的难点及相关因素,探讨再手术方式及并发症的防治措施,以期降低再手术时并发症的发生率。方法2010年3月～2012年6月腰椎间盘突出症微创介入治疗后再手术患者43例,分析微创介入治疗失败的原因,再手术的手术方式,并发症及效果。结果腰椎间盘突出症微创介入治疗后再手术的主要原因有：①椎间盘突出,钙化。②椎间隙变窄,腰椎不稳。③椎管、神经根管狭窄。④椎管内黏连瘢痕形成。再手术方式：包括摘除髓核组织;扩大狭窄的椎管或神经根管;腰椎不稳者,同时予以固定。再手术并发症：脑脊液漏,硬膜外血肿,神经根损伤,椎间隙感染等。43例均获随访,时间3—18个月,腰椎术后临床疗效评定参考侯树勋等制定的评价标准：优27例,良10例,可4例,差2例。结论腰椎间盘突出症微创介入治疗后,腰腿痛复发或症状无缓解甚至加重,原因大部分为微创介入治疗指征过于放宽。针对不同病因的患者制定个性化再手术方案可取得良好效果。腰椎间盘突出症微创介入后再手术并发症发生率明显增高,处理较棘手,临床预防此类再手术后并发症尤为重要,应引起临床医师足够重视。     

合并侧隐窝狭窄的腰椎间盘突出症的临床观察

目的:为了观察合并侧隐窝狭窄的腰椎间盘突出症的临床诊断及疗效;方法:选取资料完整的病例248例,其中合并侧隐窝狭窄的166例。本组病例均行X片、CT、MRI检查以及脊柱快速主动屈伸试验检查。结果:术前诊断合并侧隐窝狭窄的仅97例,术后诊断合并侧隐窝狭窄的有166例,漏诊率为42％。随访1～7年,平均3年8个月。术后症状完全消失的126例,症状部分消失21例,无变化及加重的19例。再次手术12例。结论:临床上,腰椎间盘突出症合并侧隐窝狭窄的发病率较高,手术时不可忽视侧隐窝的减压。     

胶原酶结合臭氧治疗腰椎间盘突出症临床观察

目的评价胶原酶结合臭氧治疗腰椎间盘突出症的疗效。方法对临床及CT或MRI确诊的腰椎间盘突出症90例,随机分2组,A组给予硬膜外前间隙注射胶原酶,B组在A组基础上椎间盘内注射臭氧。结果术后3个月随访,A组45例:显效率37.8%,有效率93.3%;B组45例:显效率68.9%,有效率95.6%,B组较A组疗效明显提高(P<0.05)。2组均无明显不良反应。结论胶原酶和臭氧联合治疗腰椎间盘突出症疗效满意。     

腰椎小关节综合征的CT诊断及与X线平片的对比

目的 评价CT对腰椎小关节综合症的诊断价值。方法 回顾分析24例腰椎小关节综合症的CT表现并与X线对比分析。结果 CT对腰椎小关节综合症的检出率明显高于X线，且对伴随椎间盘膨出、突出，侧隐窝和椎管挟窄，黄韧带肥厚和钙化，关节囊真空征等可一次性检出。结论 CT可充分显示椎小关节解剖结构和病理改变，为小关节综合征的诊断提供可靠的影像学根据。     

The natural history of sciatica: a prospective radiological study.

This prospective study was set up to record the changes in the intervertebral disc accompanying resolution of sciatica following conservative treatment. Patients presenting with sciatica (n = 165) were examined by computed tomography (CT) of the lumbar spine. Disc lesions were classified into the following groups: herniation, sequestration, generalized bulge and focal bulge. Follow-up CT of the pathological disc was performed in 106 of the 165 patients after 1 year and identical anatomical sections were compared. All patients were initially treated conservatively by the injection of steroid and local anaesthetic at the intervertebral disc/nerve root interface. Of 84 cases of disc herniation and sequestration 64 (76%) showed either complete or partial resolution on follow-up CT examination. Of 22 cases with either a generalized or focal bulge of the disc 18 (82%) were unchanged on follow up. The classical disc herniation in a young patient is the type of disc lesion most likely to show greatest improvement at follow-up CT.     

Sequestered disc herniation mimicking psoas abscess: A rare case report

Intervertebral disc herniation is common condition, with majority occurring in lumbar and cervical spine. Most lumbar disk herniations occur within the spinal canal, with approximately 7%-10% identified within the foramen or extraforaminal location. Extraforaminal disc herniation in extreme lateral, retroperitoneal or anterior terms are used when disc material is seen towards anterolateral or anterior to the spine. Disc herniation in these locations is easily mistaken for an abscess or a neoplasm especially when it is not connected to the parent disc (sequestered disc). We describe a case of 60-year male who initially was misdiagnosed as psoas abscess and subjected to invasive investigation which later turned out to be histologically confirmed disc sequestration in the retroperitoneum. Thus, knowledge of this condition is essential in avoiding unnecessary workup and treatment.     

The effect of spondylosis on the outcome of chemonucleolysis

In an attempt to understand the relation between the outcome of chemonucleolysis treatment of lumbar discs and the presence of spondylosis (degenerative process) of the lumbar spine, 40 cases of disc herniation with subsequent intradiscal chymopapain injection (chemonucleolysis) were reviewed. Thirty-eight patients had plain radiographs, 25 had myelography, 28 had computed tomography (CT), and 15 had both myelography and CT. A review of these examinations revealed that 24 patients had minimal or mild spondylosis (group 1) and 13 patients had moderate spondylosis (group 2). Only one patient had a severe spondylosis (group 3). Chemonucleolysis failed in 8/24 (33%) patients from the first group and 2/13 (15%) cases from the second group. Therefore, the presence or absence of even moderate spondylosis did not affect the treatment success rate. A review of the 11 failed cases revealed spinal canal stenosis in three cases and a large disc herniation in two (one case with a myelographic block). Another case had a sequestered disc fragment. In two further cases, the disc herniation was far lateral with complete occlusion of the lateral foramen; another case exhibited severe degenerative changes of facet joints. In two other cases, treatment failure could not be explained by any radiographic finding. Of three patients with large disc herniation, only one responded successfully to intradiscal injection of chymopapain. Chemonucleolysis, however, failed in the only patient in the third group who had severe spondylosis of the facet joint.     

侧前入路经皮穿刺靶点髓核摘除联合水针刀治疗腰椎间盘突出症

目的:探讨侧前入路经皮穿刺腰椎间盘靶点髓核摘除术(APLD)治疗L4～5椎间盘突出的可行性,并联合水针刀行椎间孔内、外口松解提高疗效。方法:经CT或MRI证实并与临床症状相符的30例旁侧型L4～5椎间盘突出患者,5例合并轻度髓核脱出,均在"C"形臂监视下行APLD,并联合水针刀行相应椎间孔内、外口松解术。所有病例均获3个月以上随访。结果:本组30例,显效率为80.0%(24/30),有效率为13.3%(4/30),无效率为6.7%(2/30),总有效率为93.3%(28/30),无严重并发症。结论:APLD治疗L4～5椎间盘突出症具有可行性,联合水针刀行椎间孔内、外口松解术,效果满意。