硬膜外腔注药并独活寄生汤治疗腰椎间盘突出症160例

我科从 1998年 6月～ 2 0 0 0年 1月门诊采用硬膜外腔注药并独活寄生汤治疗腰椎间盘突出症 16 0例 ,取得满意效果 ,现报道如下。1　临床资料　　 16 0例患者 18岁～ 90岁 ,男性 90例 ,女性 70例 ;发病时间2周～ 10年 ;腰椎间盘突出部位 :Ｌ4～ 532例、Ｌ5～Ｓ14 2例、Ｌ3～ 4并     

老年人腰椎间盘突出症的特点和骶管注药的临床应用

老年人腰椎间盘突出症的特点和骶管注药的临床应用卓峰关桂春陈诗径（上海市静安老年医院骨科，上海２０００４０）朱光泽（长春中医学院附属医院）作者简介：卓峰，男，４７岁，主治医师我院自１９８９年以来根据老年人腰椎间盘突出症的特点，应用骶管内注射确炎舒松复合...     

硬膜外注射加超短波治疗腰椎间盘突出症146例

1990～ 2 0 0 0年 ,我们采用硬膜外穿刺注射加超短波治疗腰椎间盘突出症所致的神经根炎性改变 (充血水肿 ) 146例 ,效果显著。现报告如下。一般资料 :本组男 10 2例 ,女 44例 ;年龄 2 4～ 6 6岁 ,平均42 .70岁。其中腰 4～ 5间隙 86例 ,腰 5～骶 1间隙 43例 ,腰 4～ 5和腰 5～骶 1两间隙者 17例。主要临床表现为腰痛伴放射性下肢剧痛 ,咳嗽或腹压增加时加重 ,椎旁压痛及叩击痛 ,患侧直腿抬高试验 30°～ 6 0°阳性 ,CT检查示腰椎间盘突出伴一侧神经根水肿。治疗方法 :取侧卧位 ,患侧在下 ,选择腰 3～ 4或腰 4～ 5间隙 ,行硬膜外穿刺 ,注入 …     

腰椎关节松动术结合骶管注药治疗腰椎间盘突出症

腰椎间盘突出症是临床近年多发病,好发于青壮年。我院自2007年2月至2011年2月采用腰椎关节松动术结合骶管注药治疗腰椎间盘突出症,收到了良好的临床疗效,现报道如下。 1 临床资料     

腰椎间盘突出症的个体化治疗

<正>腰椎间盘突出症(LDH)是引起腰腿痛的常见病因,主要是因为腰椎间盘不同程度的退变,髓核突破纤维环,突出或脱出于后方椎管内,压迫或刺激相应的脊神经根、马尾神经,造成腰痛、单侧或双侧下肢麻木、疼痛等一系列症状。LDH的治疗方法众多,国内外学者〔1〕认为80%⁹0%的LDH患者可以通过非手术治疗而获得较满意的缓解,仅有10%90%的LDH患者可以通过非手术治疗而获得较满意的缓解,仅有10%¹8%的LDH患者最终需要手术治疗。本文旨在探讨针对不同程度的LDH选择阶梯式治疗,以达到更好的治疗效果。     

硬膜外腔前间隙注射胶原酶治疗腰椎间盘突出症136例临床观察

自1998年以来，我们采用硬膜腔前间隙注射胶原酶治疗腰椎间盘突出症136例，效果良好。现报告如下。临床资料：本组136例中，男72例，女64例；年龄19～55岁；病史1～3年。均经CT或MRI检查确诊。临床表现为腰痛114例，下肢疼痛、麻木135例，脊柱侧弯63例，棘间压痛121例。直腿抬高试验阳性133例。CT与MIR示本组患者的椎间盘均突出并压迫硬膜囊或神经根，其中L4～5突出39例，L5～S1突出84例，L4～5与L5～S1均突出13例。     

侧隐窝及椎间孔注药联合推拿治疗腰椎间盘突出症效果观察

目的观察侧隐窝、椎间孔注药联合推拿疗法治疗腰椎间盘突出症的效果。方法腰椎间盘突出症患者300例,随机分为三组,各100例。A组采用侧隐窝和椎间孔注药(配方:康宁克通A 10 mg,利多卡因60 mg,维生素B121 000μg,加生理盐水至8 m L)联合推拿疗法(腰部按压、斜扳、直腿抬高),B组仅予侧隐窝和椎间孔注药治疗,C组单用推拿疗法。治疗后3~4周计算优良率及治愈率,记录A、B组局部注药次数及药物用量。分别于治疗后3、6、12个月观察复发情况。记录治疗期间的并发症及不良反应发生情况。结果治疗后3~4周,A组治愈率、优良率高于B、C组(P均<0.05)。A组注药次数及康宁克通A用量低于B组(P均<0.05)。治疗后6、12个月,A、C组复发率低于B组(P均<0.05)。A、B组注药时均未出现全脊髓麻醉、马尾综合征及肌无力等神经损伤现象。C组治疗后3例出现腰痛加重,经卧床休息2~3 h恢复到治疗前。结论侧隐窝、椎间孔注药联合推拿治疗腰椎间盘突出症疗效较好,复发率低。     

腰椎间盘突出症257例手术治疗体会

1991年3月～2004年11月,我们对257例腰椎间盘突出症患者行手术治疗,取得较好疗效。现介绍体会。     

腰椎间盘突出症手术患者护理体会

1996～ 2 0 0 2年 ,我院手术治疗腰椎间盘突出症 98例 ,疗效优良率达 95 .9%。现将护理体会报告如下。临床资料 :本组男 6 5例 ,女 33例 ;年龄 16～ 6 8岁 ,平均4 2岁。病程 0 .5～ 10年。全部病例手术前均经 CT扫描或MPT检查诊断为腰椎间盘突出症 ,采用椎板开窗、半椎板减压、全椎板减压术式治疗。手术结果优 (症状完全消失 ,恢复原来工作 ) 71例 ,良 (症状消失 ,劳累后腰痛 ,但不影响工作 ) 2 3例 ,尚可 (轻微腰痛 ,需改变工种 ) 4例 ,总优良率达 95 .9%。护理体会 :1术前护理 :加强心理护理 ,训练患者在床上大、小便 ,嘱其戒烟 ,多做深…     

Chemonucleolysis of lumbar intervertebral disc prolapse with chymopapain: Outcome after 1 year

Summary One hundred and one consecutive patients with lumbar disc prolapse were treated by chymopapain chemonucleolysis and their response and favourable pre-treatment criteria determined. Most improvement occurred within the first month, and one year after treatment outcome was judged satisfactory (excellent or good) in 71%. Individual patient characteristics associated with a satisfactory response were sciatica of greater severity than back pain (p=0.005) and duration of symptoms less than 18 months (p=0.03). Patients fulfilling 3 or 4 of four immediate pre-treatment clinical and radiographic criteria (sciatica more severe than back pain, reduced straight leg raising, neurological deficit, radiographic abnormality) had a satisfactory response more often than others (p<0.05). Reported success one year after surgery for disc prolapse is similar. Chemonucleolysis, however, requires less resources and does not preclude subsequent operation. Our results therefore suggest that it might be considered an alternative to surgery when conservative treatment has failed.     

腰椎间盘突出症翻修的原因分析和应对方法

目的分析腰椎间盘突出症初次手术失败的原因,探讨翻修的应对方法和疗效。方法对2005-05以来收治的38例腰椎间盘突出症术后复发的原因进行分析,并实施翻修手术。结果翻修的主要原因为初次手术不够彻底、多间隙突出遗漏及术后出现腰椎失稳等。实施翻修手术后优28例,良6例,可3例,差1例。优良率为89.5%。结论对复发的腰椎间盘突出症实施椎间融合,后路椎弓根系统内固定术,可获得满意的疗效。     

Evaluation of humoral immune response to nosocomial pathogen and functional status in elderly patients with sepsis

The clinical significance of humoral immune response to nosocomial pathogens and functional status in elderly patients with sepsis is not clear. We evaluated the humoral immune to nosocomial pathogens and the effect of functional dependencies on clinical outcomes among elderly patients with sepsis. This study prospectively enrolled patients aged ≥65 years with sepsis from September 2011 to May 2012 at a 2000-bed university hospital. The data including CD4 and CD8 T-cell count, functional status by measuring basic activities of daily living (ADL) and instrumental activities of daily living (IADL) were collected for all patients. In addition, the collected blood samples were analyzed for serum antibody levels against nosocomial pathogens using an ELISA. During the study period, 72 patients (38 males) treated with sepsis were enrolled. The all-cause in-hospital mortality rate was 16.7% (12/72). The mean CD4/CD8 T-cell ratio was significantly lower in nonsurvivors than in survivors (1.08 ± 0.72 vs. 1.93 ± 1.42, P = 0.003). Serum antibody titers to Acinetobacter baumannii, Klebsiella pneumonia, Stenotrophomonas maltophilia, and Enterococcus faecalis were statistically higher in nonsurvivors than in survivors. On multivariate analysis, the IADL score was independently predictive of mortality in elderly patients with sepsis (odds ratio 1.410, 95% confidence interval 1.007–1.975, P = 0.046). These results suggest that IADL scores could be used as predictors to identify elderly patients with a poor prognosis of nosocomial infections.     

悬吊核心肌群训练治疗腰椎间盘突出症的临床疗效观察

目的 观察悬吊核心肌群训练治疗腰椎间盘突出症的临床疗效及其对竖脊肌、多裂肌积分肌电值(iEMG)的影响.方法 选择2018-01～2020-11吉林省一汽总医院康复医学科收治的64例腰椎间盘突出症患者,采用随机数字表法将其分为观察组和对照组,每组32例.对照组采用常规康复治疗,观察组在对照组治疗方案基础上增加悬吊核心肌...     

Alloantibodies,autoantibodies, and immune complexes in patients with lung cancer

The sera of patients with lung cancer, nonmalignant lung disease, and blood donors were subjected to various immunologic assays. Nine assays, based on immunoradiometric (IRMA) and immunoenzymatic (ELISA) principles, included 3 types of fetal cell antibodies, 2 established lung cancer cell antibodies, anti-DNA, anti-IgG autoantibodies, and immune complex assays based on C1q binding and anti-C3 activity. Antitumor cell antibody level was significantly lower in patients with lung cancer compared to blood donors. In the remaining 7 assays, the lung cancer patients tended towards higher median values compared to both control patients and blood donors, but without statistical significance, with the exception of anti-DNA antibodies. Statistical analysis of all 9 assays taken together has shown significant differences between the 3 groups. When only 5 assays were used to assess 3 types of fetal cell antibodies, anti-DNA antibodies, and immune complexes by means of ELISA anti-C3, the margins between groups increased. A range of values for the selected assays was established that may discriminate 70% of tested individuals of the 3 groups. These results suggest the existence of a characteristic profile of deranged humoral immunity in lung cancer patients.     

Neck and back pain and intervertebral disc degeneration: role of occupational factors

Back pain is a near-universal human experience at some time during life, and neck pain is also common. The overwhelming majority of low back and cervical pain is considered to be due to unspecified mechanical factors or disc degeneration, which is a common with ageing and, hence, in people of working age. Back pain and disc disease appear to have significant heritability, based upon twin studies, but environmental factors also contribute - including physical occupational activities in some studies - although the strength of this association remains uncertain. This article examines the contribution of genetic and environmental factors to back pain and disc disease, with a specific focus on occupational exposures.     

Effect of continuous lumbar traction on the size of herniated disc material in lumbar disc herniation

We investigated the effects of continuous lumbar traction in patients with lumbar disc herniation on clinical findings, and size of the herniated disc measured by computed tomography (CT). In this prospective, randomized, controlled study, 46 patients with lumbar disc herniation were included, and randomized into two groups as the traction group (24 patients), and the control group (22 patients). The traction group was given a physical therapy program and continuous lumbar traction. The control group was given the same physical therapy program without traction, for the same duration of time. Data for the clinical symptoms and signs were collected before and after the treatment together with calculation of a herniation index, from the CT images that showed the size of the herniated disc material. In the traction group, most of the clinical findings significantly improved with treatment. Size of the herniated disc material in CT decreased significantly only in the traction group. In the traction group the herniation index decreased from 276.6±129.6 to 212.5±84.3 with treatment (p<0.01). In the control group, pretreatment value was 293.4±112.1, and it decreased to 285.4±115.4 after the treatment (p>0.05). Patients with greater herniations tended to respond better to traction. In conclusion, lumbar traction is both effective in improving symptoms and clinical findings in patients with lumbar disc herniation and also in decreasing the size of the herniated disc material as measured by CT.     

系统性红斑狼疮患者体液免疫和ENA酶谱变化及意义

目的　探讨体液免疫和可提取性核抗原 (ENA)酶谱在系统性红斑狼疮 (SL E)稳定期和活动期中的变化及意义。方法　应用散射速率比浊法检测 5 2例 SL E患者 (下称实验组 )以及 2 4例正常对照者 (对照组 )的Ig G、Ig A、Ig M、C3、C4 等水平 ,应用免疫印记技术检测 ENA酶谱。结果　实验组血清 Ig G、Ig A水平明显高于对照组 ,其中活动期 (实验 B组 )血清 Ig G、Ig A、Ig M高于稳定期患者 (实验 A组 )。实验组血清 C3、C4 水平明显低于对照组 ,且实验 B组 C3水平明显低于实验 A组 ,差异有显著性 (P<0 .0 1)。 4 5 .4 % SL E患者抗 SSA、抗 SSB同时阳性 ,抗 ds DNA阳性率为 32 .7%。抗 r RNP和抗 Sm抗体在实验 A、B组的阳性率有显著差异 (P<0 .0 1,<0 .0 5 ) ,其他抗体均无明显差异。结论　 SL E患者行体液免疫指标及 ENA酶谱测定可提示其疾病进展情况。     

显微内窥镜治疗青中年外伤性腰椎间盘突出症的临床疗效观察

目的评估显微内窥镜腰椎间盘切除系统(microendoscopy discectomy,MED)治疗外伤性腰椎间盘突出症的临床效果及应用价值。方法收集并分析2010-01~2014-09在该院行MED治疗的67例外伤性腰椎间盘突出症患者的临床资料,其中男39例,女28例,统计患者的手术时间、术中出血量、术后第1天引流量及住院时间,采用疼痛视觉模拟评分(VAS评分)及改良Macnab评分标准评判手术前后患者疼痛改善情况及腰部功能恢复情况。结果该组患者术后随访1年以上,手术时间为(53.88±12.33)min,术中出血量为(37.53±12.69)ml,术后第1天引流量为(16.49±8.96)ml,术后住院时间为(5.97±1.54)d。术后1、3、6、12个月VAS评分均有明显降低,与术前相比差异有统计学意义(P0.05)。末次随访时按改良Macnab疗效评定标准,优52例(77.61%),良10例(14.92%),可4例(5.97%),差1例(1.49%),优良率为92.54%。结论MED应用于外伤性腰椎间盘突出症的治疗有着其独到的优势。     

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.