老年腰椎管狭窄症合并腰椎不稳的手术治疗

腰椎管狭窄症是65岁以上老年人常见的脊柱疾病,多合并有不同程度腰椎节段不稳,大多数患者经保守治疗无效,在不稳定的晚期,可出现各种脊柱畸形、神经根以及马尾受压症状,行单纯手术减压治疗远期疗效欠佳,是脊柱外科医生面临的一个常见问题.我院2001年12月-2006年12月,采用全椎板及侧隐窝神经根管减压、后外侧植骨和椎弓根内固定术治疗老年腰椎管狭窄症合并腰椎不稳患者19例,经10～60个月随访,效果优良,现报道如下.     

小切口椎板间开窗治疗腰椎间盘突出症

小切口椎板间开窗治疗腰椎间盘突出症金乡县人民医院（２７２２００）李新军尹西平张峰１９９０～１９９５年，我们采用小切口手术治疗腰椎间盘突出症患者１１４例，疗效满意。现报告如下。临床资料：本组男４４例，女７０例；年龄１７～５９岁；病程２个月至２０年。病变...     

腰椎旁神经阻滞加三维牵引治疗腰椎间盘突出症57例

2009年以来,我院采用腰椎旁神经阻滞加三维牵引治疗腰椎间盘突出症57例,取得良好效果,现报道如下. 1 资料与方法 1.1 一般资料 57例均为住院患者,均符合<疼痛诊疗学>中腰椎间盘突出症的诊断标准.其中男30例,女27例;年龄19～52岁,平均38岁;病程3d～10年,平均1年;L3～4突出者15例,L4～5突出者31例,L5～S1突出者35例,L4～5合并L5～S1突出者20例;右下肢放射痛30例,左下肢放射痛23例,仅腰痛8例,腰痛合并腿痛、下肢麻木者12例.治疗前均排除其他原因引起的腰腿痛.     

医源性腰椎不稳症的治疗方法探讨

2000年1月～2005年12月共收治35例医源性下腰椎不稳症患者,保守治疗6例,再次手术29例,其中单纯性腰椎不稳症4例,术后椎间不稳伴间盘突出者20例,滑脱不稳11例。结果发现,术后随访2～7a、平均2．9a,原有的腰腿痛症状均明显缓解,大多数患者恢复原正常的工作和生活;VAS疼痛分值术前平均为8．3分,术后下降至平均3．2分;功能评定结果：优15例、良17例,可3例,差0例,优良率为91．4％;骨融合率达97．1％。认为有临床症状又有相对应的影像学支持且经过3—6个月保守治疗无效或加重是退行性腰椎不稳症的手术适应证;术前全面评估,有针对性的选择手术方式,可以获得较好的临床疗效。     

腰椎失稳症手术治疗中应用融合器cage的体会

2003年2月～2005年5月,笔者在24例腰椎失稳症手术治疗中应用椎间融合器cage,取得了满意疗效。现报告如下。     

后半游离嵌入植骨后回植融合治疗合并椎间盘突出的腰椎峡部裂

合并椎间盘突出的腰椎峡部裂手术治疗较复杂,我们采用先将患椎的后半部分游离取下并修整,待椎间盘切除、椎管扩大、植骨床修整后取髂骨块嵌入,再将后半部回植,用螺丝钉贯穿固定。同期行椎板间植骨。临床应用１３ 例,断端均融合,优良率为８４６％ 。认为该术式设计合理,操作相对简单,疗效确实可靠,有推广价值。     

开窗法手术治疗腰椎间盘突出症86例

目的探讨开窗法治疗腰椎间盘突出症的临床效果。方法对本组86例腰椎间盘突出症患者行开窗法髓核摘除术,对伴有腰椎管狭窄的病例同时予以扩大侧隐窝、松解神经根管。结果本组无神经根损伤,伤口均一期愈合,经过不少于6个月的临床观察,表明采用开窗法髓核摘除后,患者创伤小,功能恢复迅速,未发生下腰椎不稳,优良率达96.5%。结论使用开窗法治疗腰椎间盘突出症效果优良,较少干扰下腰椎稳定。     

腰椎间盘突出症再手术原因分析（附32例报告）

对３２例行二次手术的腰椎间盘突出症患者的临床资料进行了分析，发现再手术原因为腰椎间盘突出术后复发、另一间隙再突出、合并腰椎管狭窄、下腰椎手术失败综合征及第一次手术定位错误。     

螺旋式椎体融合器植骨融合治疗腰椎不稳的护理

1995年3月～2008年12月,我们采用自制螺旋式融椎器对156例腰椎不稳患者行植骨融合,融合率100％。现将其护理方法介绍如下。     

综合牵引治疗腰椎间盘突出症50例

1临床资料 1．1对象与治疗 腰椎间盘突出症患者50例,其中男性12例,女性38例,年龄51～65岁,平均56岁。全部病例经腰椎x线片、CT或MRI检查确诊,L3．L4椎间盘突出症18例。L4-L5椎间盘突出症23例,L5-S1椎间盘突出症9例。采用电脑控制牵引床＋微波,配合电脑中频电治疗。床分为三个部分,中间部分有12cm宽的间隙,可来回活动。患者取俯卧位,     

经皮椎间孔镜与椎板开窗手术治疗复发性腰椎间盘突出症的临床效果比较

目的比较经皮椎间孔镜与椎板开窗手术治疗复发性腰椎间盘突出症的临床效果。方法选取在该院就诊的复发性腰椎间盘突出症患者82例,按手术方式不同分为两组,各41例。对照组实施椎板开窗髓核摘除术,观察组实施经皮椎间孔镜治疗,比较两组临床疗效。结果观察组手术时间、术后卧床时间、住院时间较对照组明显缩短,术中出血量减少,差异有统计学意义(P0.01);两组患者手术前后视觉模拟评分(VAS)及功能障碍指数(ODI)评分比较,差异无统计学意义(P0.05)。结论经皮椎间孔镜与椎板开窗手术治疗复发性腰椎间盘突出症效果相似,但经皮椎间孔镜治疗可缩短手术时间、术后卧床时间及住院时间,减少术中出血量。     

腰椎间孔注射配合高频透热疗法治疗腰椎间盘突出症

目的观察腰椎间孔注射配合高频透热疗法治疗腰椎间盘突出症的临床疗效。方法运用2%利多卡因注射液5ml,曲安奈德注射液40mg,维生素B_(12)注射液0.5mg,0.9%氯化钠注射液20ml混合行腰椎间孔注射,1次/7d;间歇期配合高频透热疗法,1次/d,5d为1疗程。结果 386例患者中,治愈313例,好转49例,无效24例,有效率93.7%。结论腰椎间孔注射配合高频透热疗法治疗腰椎间盘突出症的临床效果肯定。     

脉络宁硬膜外自控式注射配合手法治疗腰椎间盘突出症

目的探索脉络宁硬膜外腔自控式注射配合推拿牵引等手法综合治疗腰椎间盘突出症(LIDH)的疗效。方法选择符合纳入标准的LIDH患者156例,随机将患者分为4组:推拿牵引手法治疗组(TMM组,n=38)、脉络宁硬膜外注射+手法治疗组(MET组,n=40)、脉络宁硬膜外自控式注射+手法治疗组(MPT组,n=36)及西药硬膜外自控式注射+手法治疗组(WPT组,n=42)。分别记录4组治疗前与每个疗程后1 d、总疗程后1个月的疼痛视觉模拟评分(VAS)值;记录治疗前和治疗后1、3个月Oswestry功能障碍指数(ODI)分值,进行ODI疗效评价,并计算优良率及有效率。结果 MET、MPT、WPT 3组患者每个疗程结束后1 d及总疗程后1个月进行VAS值测定均比TMM组降低(P<0.01或<0.05),治疗后1、3个月临床疗效评定有效率及优良率均优于TMM组(P<0.01或<0.05),但MPT、WPT组更佳(P<0.01),且疗效稳定。结论脉络宁硬膜外自控式注射配合推拿牵引等手法治疗LIDH,可使治疗周期缩短、避免多次应用类固醇激素药,且疗效稳定,该方法是其他保守疗法效果不佳又惧怕手术的LIDH患者的一种良好选择。     

Spontaneous regression of symptomatic lumbar disc herniation

Lumbar disc herniation is very common, sometimes leading to disability of the patient, and in a significant number of cases can only be solved with surgery. This paper reports a case with a large symptomatic disc herniation, which suffered spontaneous regression, and no surgery was necessary. The case is documented on serial MRI, consistent with the clinical improvement of the patient.     

腰椎间盘突出症外科治疗进展

腰椎间盘突出症是自人类出现以后就存在的疾病,医学界不断总结临床和实践经验,得出一些新的治疗技术,为治疗腰椎间盘突出症开辟新的途径。为此,文章将对腰椎间盘突出症的外科治疗概况进行综述。     

康复护理结合针灸理疗治疗腰椎间盘突出症临床疗效的Meta分析

目的比较康复护理结合针灸理疗与单一疗法治疗腰椎间盘突出症(LDH)的临床疗效,为康复护理结合针灸理疗治疗LDH的临床应用提供循证医学证据。方法采用Cochrane系统评价方法,检索中国知网数据库(CNKI)、维普数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、Cochrane Library数据库中关于报道康复护理结合针灸理疗治疗LDH临床疗效的相关文献,检索时限从建库至2019年2月,由2名研究员按照纳入与排除标准独立筛选文献、提取资料并采用Comprehensive Meta Analysis V2软件进行Meta分析。结果共纳入16项随机对照研究,共计1 504例患者。采用固定效应模型进行Meta分析。结果显示:与单一疗法相比,康复护理结合针灸理疗治疗LDH的总有效率及治愈率均有提高,差异有统计学意义(RR_(总有效率)=1.197, 95%CI 1.151～1.245,P0.001;RR_(治愈率)=1.347, 95%CI 1.225～1.541,P0.001);Egger检验及Begg检验提示无明显发表偏倚。结论康复护理结合针灸理疗治疗LDH的疗效确切,可以显著提高患者生活质量,值得临床推广应用。     

Psoas muscle measurement as a predictor of recurrent lumbar disc herniation: A retrospective blind study

AbstractParaspinal (erector spinae and multifidus) and psoas muscles contribute to spinal stability, but no study has yet examined the relationship between muscle mass and recurrent lumbar disc herniation (rLDH).The purpose of this study was to investigate the effect of psoas and paraspinal muscle mass on recurrent Lumbar disc herniation (LDH).This retrospective study included 49 patients with LDH (22 men, 27 women; mean age: 59.9 years; range 32–80) who underwent discectomy and partial laminectomy without fusion and underwent both pre- and postoperative magnetic resonance imaging. The presence of rLDH was determined using medical records and postoperative magnetic resonance imagings. Patients were divided into an rLDH group (26 patients) and a without-rLDH group (23 patients). Clinical characteristics, segmental motion, and paraspinal and psoas muscle mass were compared between the groups. Using ImageJ software, the cross-sectional area (CSA), lean muscle mass (LMM), and skeletal muscle index (SMI) were measured on T2 axial preoperative magnetic resonance images at L2-L3, L3-L4, and L4-L5 disc levels to represent muscle mass. Univariate and multivariate logistic regression analyses were performed.In the rLDH group, patients were younger (52.6 years vs 68.2 years; P = .001), segmental instability was more common (50.0% vs 4.3%; P = .001), and the CSA, LMM, CSA_SMI, and LMM_SMI of psoas muscles were larger (5851.59 mm² vs 4264.93 mm², 5456.59 mm² vs 4044.77 mm², 18.77 cm²/m² vs 13.86 cm²/m², and 17.52 cm²/m² vs 12.98 cm²/m²; P < .01 for all 4 variables). On multivariate logistic regression, age and segmental instability were independent risk factors for rLDH (odds ratio 0.886 and 18.527; P = .01 and P = .02, respectively).In middle-aged and elderly patients with lumbar disc herniation, relatively younger age, segmental instability, and greater psoas muscle mass may be risk factors for recurrence.     

Outcomes of epiduroscopic laser ablation in patients with lumbar disc herniation

Recently, trans-sacral epiduroscopic laser decompression (SELD) using flexible epiduroscopy and laser system is 1 of the options for minimally invasive surgery in herniated lumbar disc. However, outcomes after SELD in patients with disc herniation of lumbar spine are not proven worldwide. The authors reported clinical, surgical, and radiological outcome after SELD in patients with mild to moderate disc herniation.Between 2015 and 2018, eighty-two patients who underwent SELD for single level disc herniation with a minimum follow-up of 6.0 months were investigated retrospectively. Clinical outcomes were assessed using the visual analog scale for low back and leg pain and Odom''s criteria for patient satisfaction. Also, surgical outcomes, including complications, recurrences, and revision surgeries, and radiological outcomes using regular simple radiograph were analyzed.The mean visual analog scale score of low back pain and leg pain improved from 5.43 ± 1.73 and 6.10 ± 1.67 to 2.80 ± 1.43 and 3.58 ± 2.08 at the final follow-up (p < 0.001). On the other hand, according to Odom''s criteria, the success rate (excellent or good results at 6 months after surgery) was 58.5%. Surgical complications occurred in 7 patients (8.5%), including dura puncture during the procedure, transient headache or nuchal pain, and transient mild paralysis. The rate of additional procedures after SELD was 17.1% (6 patients of revision surgery and 8 patients of an additional nerve block).Our findings demonstrated that SELD for lumbar disc herniation achieved less favorable patient satisfaction compared with previous studies. Further study is needed to clarify the influencing factors on the clinical outcomes of SELD.     

Brucella disc infection mimicking lumbar disc herniation: a case report

Brucellosis is a zoonotic disease and still a major health problem in many geographical areas. In this paper a forty year-old woman with spinal brucellosis associated with epidural abscess formation and mimicking lumbar disc herniation is presented. Compression of spinal nerve root(s) by epidural masses due to brucella disc infection is a rare condition and should be kept in mind in differential diagnosis of lumbar disc herniation. The crucial role of magnetic resonance imaging in differential diagnosis is also emphasised.