红外热像图在腰椎间盘突出症中辅助诊断价值的探讨

目的 该研究旨在探讨远红外热像图在椎间盘突出症（LDH）辅助诊断中的价值。方法对疼痛门诊中自诉腰痛并单侧下肢痛放射性疼痛的病人23例，随机进行红外热像图测定，并接受CT断层扫描检查。观察和分析腰骶部及下肢热形态、兴趣区域的温度及双下肢对应部位的温度差异（△T），并分析F—IRT诊断LDH灵敏度和特异性。结果 F—IRT显示：23例LDH患者腰骶部热形态改变为四种形式：梭形，热区向一侧偏歪或呈角状突起（8例）；脊中线热区不连贯（6例）；骶髂骨土缘呈大片高温热区（5例）；不规则形态（4例），患侧下肢较相对应的对侧肢体的温度，至少有一个患侧部位出现温度下降的有19例（82．61％），综合CT与F—IRT结果分析：F—IRT诊断腰椎间盘侧后突的灵敏度为90．48％，特异度为66．68％。但患侧的热区分布与椎间盘突出部位并没有明显的相关性。结论 F—IRT检查能较为精确地反映自主神经系统改变引起的体表温度的改变，在LDH的辅助诊断中有一定的价值，但尚不能进行病变椎间盘的定位。     

Anterior herniation of lumbar disc induces persistent visceral pain: discogenic visceral pain

Background Visceral pain is a common cause for seeking medical attention. Afferent fibers innervating viscera project to the central nervous system via sympathetic nerves. The lumbar sympathetic nerve trunk lies in front of the lumbar spine. Thus, it is possible for patients to suffer visceral pain originating from sympathetic nerve irritation induced by anterior herniation of the lumbar disc. This study aimed to evaluate lumbar discogenic visceral pain and its treatment. Methods Twelve consecutive patients with a median age of 56.4 years were enrolled for investigation between June 2012 and December 2012. These patients suffered from long-term abdominal pain unresponsive to current treatment options. Apart from obvious anterior herniation of the lumbar discs and high signal intensity anterior to the herniated disc on magnetic resonance imaging, no significant pathology was noted on gastroscopy, vascular ultrasound, or abdominal computed tomography （CT）. To prove that their visceral pain originated from the anteriorly protruding disc, we evaluated whether pain was relieved by sympathetic block at the level of the anteriorly protruding disc. If the block was effective, CT-guided continuous lumbar sympathetic nerve block was finally performed. Results All patients were positive for pain relief by sympathetic block. Furthermore, the average Visual Analog Scale of visceral pain significantly improved after treatment in all patients （P 〈0.05）. Up to 11/12 patients had satisfactory pain relief at 1 week after discharge, 8/12 at 4 weeks, 7/12 at 8 weeks, 6/12 at 12 weeks, and 5/12 at 24 weeks. Conclusions It is important to consider the possibility of discogenic visceral pain secondary to anterior herniation of the lumbar disc when forming a differential diagnosis for seemingly idiopathic abdominal pain. Continuous lumbar sympathetic nerve block is an effective and safe therapy for patients with discogenic visceral pain.     

116例腰椎间盘突出症MR椎管水成像形态分析

[目的]探讨腰椎间盘突出症磁共振脊髓造影(MRM)形态与临床表现的相关性。[方法]对116例腰椎间盘突出症患者进行MRM检查并观测其形态,分析形态与临床表现的关系。[结果]腰椎间盘突出症的MRM形态呈现多种表现,腹面缺损程度与腰椎间盘向椎管内突出严重程度相关(P<0.01),但充盈缺损程度与疼痛程度相关不显著(P>0.05)。[结论]MRM检查安全、无X线损伤,是常规MRI的有效补充,可为腰椎间盘突出症治疗方法的选择提供较好的“造影”图像和更多的空间结构信息。     

IL-8及TNF在突出椎间盘中的表达意义

目的探讨白细胞介素-8（IL-8）及肿瘤坏死因子（TNF）在退变椎间盘炎性反应中的作用机制。方法用放免法测量正常组、退变组椎间盘组织中IL-8及TNF的含量,并通过统计学软件进行分析比较。结果正常组IL-8及TNF浓度极低或不存在,而退变各组均能观察到这两种炎性因子的存在,并且其产生随突出程度的不同而各异：在退变早期阶段（膨出型组）IL-8及TNF的含量较低,而随突出程度的加重（突出型组、游离型组）,这两种炎性介质的含量明显增加,存在统计学上的差异性。结论退变椎间盘能自发产生IL-8及TNF,可导致MMP3的大量合成,过量的MMP3引起大量的巨噬细胞聚集在突出椎间盘的周围,从而加重了间盘周围的炎性反应,加速了突出椎间盘的吸收。     

腰椎间盘突出症患者椎管MRM水成像形态与临床表现关系的分析

目的探讨腰椎间盘突出症MRM形态与临床表现的相关性。方法对138例腰椎间盘突出症患者进行腰椎MRM检查并观测其形态,分析形态与临床表现的关系。结果腰椎间盘突出症的MRM形态呈现多种表现,腹面缺损程度与腰椎间盘向椎管内突出严重程度有关（P〈0.01）,但充盈缺损程度与腰部疼痛程度无关（P〉0.05）;神经根鞘袖内脑脊液缺损程度与神经根疼痛程度有关（P〈0.05）。结论MRM较MRI或CT能更真实地反映腰椎间盘突出症患者神经根受压状态,与临床症状体征较一致,是CT或MRI的重要补充。     

QCT测量腰椎间盘突出患者骨密度的研究

目的利用QCT（定量CT）研究腰椎间盘突出症患者与正常人骨密度差异,探讨腰椎间盘突出症对骨密度的影响,旨在研究骨量减低的危险因素。方法应用定量CT技术测量50例腰椎间盘突出患者和50例健康志愿者的腰椎骨密度,对病例组和对照组骨密度进行比较分析。结果腰椎间盘突出症组患者的骨密度较正常对照组骨密度值无显著性差异（P〉0.05）。结论腰椎间盘突出症患者骨密度未见明显降低,腰椎间盘突出症对骨密度的影响不明显,腰椎间盘突出症并非骨量减低的危险因素。     

胸椎间盘突出症的手术治疗(附19例报告)

目的：探讨胸椎间盘突出症的诊断和治疗方法，方法：对19例中央型、旁正中型、外侧型胸椎间盘突出症进行了椎板切除减压和椎体后外侧切除肋骨横突入路手术治疗，观察其疗效。结果：疗效令人满意，其中9例优，6例良，2例可，2例差，结论：后外侧切除肋骨横突入路对中央型胸椎间盘突出摘除彻底，而半椎板切除对外侧或软性胸椎间盘突出比较适宜。     

Effect of AGEs on human disc herniation: intervertebral disc hernia is also effected by AGEs

Currently, extracellular matrix MMP has been discussed in relation to the extrusion and spontaneous regression of the herniated mass observed in lumbar disc herniation. However, the question remains as to whether degenerated protein is really the cause of this condition's pathogenesis. We confirmed immunologically by means of electron microscopy that extrusion is caused by the AGEs (advanced glycation end products)-induced cross-linking of collagen, and that spontaneous regression is due to AGE receptors on macrophages. Further, AGEs were found to be already exposed during histogenesis, suggesting a relation to apoptosis. In lumbar disc herniation and aging, glucose-derived AGEs cross-link proteins and cause vascular tissue damage.     

Calcified thoracic disc with herniation of the nucleus pulposus in a child

A twelve year old boy presented with acute cervical and interscapular pain, torticollis and low grade fever. The neurological examination was normal. Roentgenograms showed calcification of the T3-T4 disc and posterior herniation of the nucleus pulposus was demonstrated by computed tomography. A rapid and dramatic amelioration of the symptoms was produced by treatment with a non-steroidal anti-inflammatory drug. Intervertebral disc calcification in childhood is an uncommon and usually benign condition. Its clinical and radiological features are discussed in the light of the relevant literature.     

极外侧型腰椎间盘突出症的临床特征及治疗

目的探讨极外侧型腰椎间盘突出症的临床特征和术式选择.方法13例极外侧型腰椎间盘突出症患者中,椎间孔内型8例,椎间孔外型5例.分别采用单侧后路椎板减压、切除关节突关节、摘除椎间盘,并进行后路椎间植骨融合内固定手术和横突间入路单纯摘除椎间盘手术.结果13例患者均获得随访,平均随访18个月.疗效按照Macanab分级和VAS评定：本组优8例,良4例,可1例,差0例,总优良率92.31%.术前腿痛平均VAS评分为8分,术后为1.4分,术前腰痛VAS评分为1.6分,术后为1分.结论对椎间孔内型采用单侧后路椎板减压、髓核摘除间植骨融合内固定术;对椎间孔外型,采用横突间入路单纯摘除椎间盘术疗效满意.     

经皮腰椎间盘髓核切吸术疗效分析

目的　探讨CT水平面图像腰椎间盘突出角度、矢状面图像突出髓核中心位置与APLD疗效的关系。方法　将 49例经皮切吸术治疗的病例分为两组。A组 :CT水平面图像 ,椎间盘突出角≥ 1 1 0°,矢状面图像突出髓核中心位于该节段椎间盘间隙高度内 2 2例 ;B组 :CT水平面图像 ,椎间盘突出角 <1 1 0° ,矢状面图像突出髓核中心在该节段椎间盘间隙高度之外 2 7例。结果　 49例随访 1 6～ 35个月 ,平均 2 2 9个月。A组有效率 90 91 % ,B组有效率 59 2 6% (P <0 .0 5)。结论　通过对CT扫描水平面图像腰椎间盘突出角度、矢状面图像突出髓核中心位置的仔细分析能基本预测APLD的疗效。     

腰椎间盘突出症的CT及MR诊断价值比较分析

目的：分析CT及MR诊断腰椎间盘突出症的临床价值。方法随机选择该院2012年5月—2014年9月收治的50例腰椎间盘突出症患者作为观察对象,对50例腰椎间盘突出症患者采用CT及MR检查,CT检查结果作为对照组数据,MR检查结果作为实验组数据,以临床病理检验结果作为金标准,该研究所选患者均为临床病理诊断确诊患者,对比两种检查方式对于诊断腰椎间盘突出症的价值。结果对照组诊断准确率为84.00%,椎间盘突出患者38例,椎间盘脱出4例;实验组诊断准确率为96.00%,椎间盘突出患者42例,椎间盘脱出6例;组间诊断准确率差异有统计学意义(P﹤0.05)。结论针对腰椎间盘突出症患者采用MR检查的诊断价值高于CT检查的诊断价值,MR检查应作为诊断腰椎间盘突出症的首选方式。     

A Study on Extension－Flexion Dynamic Lumbar Spine Radiographsin Patients with Lumbar Intervertebral Disc Herniation

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矢状面平衡参数与脱出腰椎间盘重吸收关系的回顾性研究

  目的  研究腰椎间盘脱出以及脱出重吸收后腰椎-骨盆矢状面参数相应的改变。  方法  收集2010年5月?2019年3月按北美脊柱协会（NASS）推荐的诊断标准、诊断为腰椎间盘脱出患者的资料,依据随访时影像检查显示的脱出椎间盘吸收程度,将患者分为吸收组〔突出椎间盘完全消失,或残留的椎间盘局限在按美国密歇根州立大学（Michgan State University,MSU）学者提出的影像学分型的1级之内〕和未吸收组（脱出间盘未发生变化,或虽有缩小但突出仍超过1级）,站立位照片确定骨盆-脊柱参数〔包括骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）和腰椎前凸角（LL）〕,通过多因素方差分析比较两组前后各参数之间的变化。  结果  共计67例腰椎间盘脱出症患者纳入本研究,患者症状都得到了满意的缓解。其中吸收组37例,平均年龄42.6岁,男21例,女16例,腰4～5椎间盘脱出13例,腰5骶1椎间盘脱出24例,平均随访 22个月;未吸收组30例,平均年龄40.8岁,男19例,女11例,其中腰4～5椎间盘脱出12例,腰5骶1椎间盘脱出18例,平均随访21个月。两组比较,年龄、性别、吸烟史、慢性病史、突出节段、MSU分型、随访时间等基线情况差异均无统计学意义（P>0.05）。在随访结束时,吸收组矢状面30例移位全部消失,突出间盘从初始的MSU分型2级19例、3级18例变为吸收后残留间盘全部局限在1级以内;未吸收组矢状面移位从20例减少到14例,突出间盘从初始的MSU分型2级21例、3级9例变为2级27例,3级3例。治疗前两组比较,各脊柱-骨盆参数（PI、SS、PT、LL）差异均无统计学意义（P>0.05）;治疗后（随访结束时）比较,两组PI差异无统计学意义（P>0.05）,吸收组SS、LL均值大于未吸收组,PT均值小于未吸收组,差异有统计学意义（P<0.05）。组内比较,吸收组治疗前后PI、SS、PT差异无统计学意义（P>0.05）,LL治疗后变大,差异有统计学意义（P<0.05）;未吸收组治疗前后脊柱-骨盆各参数差异均无统计学意义（P>0.05）。  结论  间盘脱出重吸收后导致脊柱-骨盆参数发生相应的变化,反之,脊柱-骨盆参数的改变表明腰椎能更好地缓冲负荷,减轻间盘压力,从而导致间盘重吸收的发生。     

Chemonucleolysis for relief of sciatica due to a herniated intervertebral disc.

Chemonucleolysis is the nonoperative chemical removal of displaced lumbar disc material. The enzyme chymopapain, which has a wide margin of safety between its effective therapeutic and toxic doses, is effective in the management of sciatica due to a herniated intervertebral disc. The patient will have leg pain as the dominant symptom and a 50% reduction in straight-leg raising with or without bowstring discomfort and crossover pain. Neurologic symptoms and signs are usual, as are abnormal results of contrast studies, which will verify the level of involvement. In 220 randomly selected patients who met criteria for the diagnosis of sciatica due to a herniated intervertebral disc and did not have psychogenic or nonorganic spinal pain, a spinal stenosis or a history of a previous, unsuccessful operation to relieve the sciatica, chemonucleolysis had a success rate of 80%. The only complications were a severe anaphylactic reaction in two patients and lesser, delayed reactions in five others. All of the reactions were successfully treated. Of the 45 patients in whom chemonucleolysis was unsuccessful, 38 underwent a laminectomy. In 3 of the 38 the results of chemonucleolysis were initially good, but later the disc herniation recurred; thus, the long-term treatment failure rate was 1.4%.     

颈椎后路一次性手术治疗颈椎管狭窄合并颈椎间盘突出

目的探讨颈椎管狭窄合并颈椎间突出一次性后路减压和髓核摘除的手术方法以及手术时应注意的问题。方法 :经颈椎后路摘除椎间盘 38例。局麻、俯卧位 ,颈椎后路单开门椎管扩大成形后 ,以病变间隙为中心 ,纵行切开硬脊膜 ,根据需要切断病变侧 2～ 3条齿状韧带 ,将脊髓轻轻向中线牵拉 ,摘除突出的髓核。结果 :38例中 35例获得平均 3年 2个月 (6个月～ 7年 10个月 )的随访 ,优 2 1例 ,良 11例 ,有效 3例 ,避免前、后路 2次手术 ,效果满意 ,但应选择好手术适应证 ,手术操作时应注意对脊髓和神经根的牵拉以及对齿状韧带与神经根的辨认等问题。     

盘内注射胶原酶治疗颈椎间盘突出症的临床观察

目的对颈椎间盘盘内注射胶原酶治疗颈椎间盘突出症的疗效进行评估。方法对37例颈椎间盘突出症患者,将国产胶原酶冻干制品300 U溶于生理盐水0．3 ml中,于局部麻醉和影像增强监视下注入突出的椎间盘盘内。所有患者在注射前后均作影像学评价。结果术后6～12个月的随访观察表明,37例患者中32例(占86．5％)疼痛明显减轻或消失,临床效果满意;3例(8．1％)效果可;2例(5．6％)效果不满意。6个月CT复查结果显示,突出物较术前缩小80％以上的有9例,缩小50％-79％的有21例,缩小20％-49％的有5例,未超20%的有2例,优良率达81％。结论对于颈椎间盘突出症,胶原酶颈椎间盘化学松解术是一种有效的治疗方法。     

FasL受体在突出腰椎间盘髓核细胞中的表达及意义

目的:检测突出的腰椎间盘髓核中FasL受体的表达情况,探讨其与腰椎间盘突出症发生与发展的关系。方法:根据美国矫形外科学会(AAOS)及国际腰椎研究会(ISSLS)分类,将20例术中取出的腰椎间盘突出症患者髓核标本分成退变组(10例)、脱出组(10例),并以7例外伤性脑死亡青年患者作为正常对照组,应用免疫组化法检测髓核中FasL受体表达情况并通过电镜查找凋亡细胞。结果:(1)FasL受体主要定位于细胞膜,呈均匀的棕黄色细颗粒状或粗细不等;(2)3组FasL阳性表达率明显不同(P<0.05);(3)Fas阳性表达率的高低同年龄有关(r=0.4102,P<0.05),但与性别及病程无关;(4)电镜可观测到细胞凋亡的一些形态学变化。结论:腰椎间盘、突出髓核细胞中存在FasL受体的表达,突出类型不同,FasL受体表达的程度也不同,其异常表达诱导了髓核细胞的凋亡,可能在腰椎间盘突出症的发病过程中起着重要作用。     

中青年颈椎间盘突出症的CT对照分析

目的探讨无症状组及有症状组中青年颈椎间盘突出症在CT上的区别。方法搜集无症状及有症状中青年受检者300例及125例,对两组颈椎间盘突出的临床及CT表现特点进行对照分析。结果有症状组椎间盘突出检出率为81.2%(102/125),突出椎间盘198节,突出程度3.63±0.20mm,椎管狭窄8.6%(17/198),黄韧带肥厚19.2%(38/198),椎体及椎小关节增生40.9%(81/198),无症状组椎间盘突出检出率为42.3%(127/300),突出椎间盘159节,突出程度2.13±0.11mm,椎管狭窄1.3%(2/159),黄韧带肥厚8.2%(13/159),椎体及椎小关节增生35.2%(56/159)。两组除椎体及椎小关节增生外均有明显统计学差异(P<0.05)。结论有症状组在椎间盘突出检出率、突出程度、椎管狭窄、黄韧带肥厚等方面均较无症状组明显,颈椎间盘突出达3.6mm以上或合并椎管狭窄、黄韧带肥厚者发展为颈椎病的可能性较大,应予以早期治疗。CT可以早期发现颈椎间盘突出、突出程度等信息,是颈椎间盘突出症重要检查方法。     

腰椎间盘突出症在重力牵引下CT及介入治疗的临床分析

目的探讨腰椎间盘突出重力牵引下的CT影像和介入治疗中髓核造影表现以及部分腰椎间盘突出症患者牵引治疗疗效差的原因,并指导介入治疗.方法选择牵引治疗效果差,欲行介入治疗的腰椎间盘突出症患者32例,共43节椎间盘,在同一台CT上,先行病变椎间隙的扫描后,用自制的牵引设备,行骨盆牵引,拉力传感器显示牵引重量,再行CT扫描,扫描参数同牵引前,并与介入治疗中髓核造影影像对照分析.结果牵引中病变椎间隙较牵引前平均增宽0.151 cm,但突出物未见明显回缩,6例7个椎间盘内明显积气.髓核造影显示:纤维环破裂23节,髓核退变明显、纤维环松驰14节,纤维环大部分断裂6节.结论牵引下突出物未见回缩的主要因素是纤维环松弛、断裂失去弹性,椎间盘内压力增高,突出椎间盘组织与周围粘连,这也是牵引效果差、容易复发的原因,在介入治疗时需要方法互补,才能显效.