老年患者腰椎手术的探讨

我们对３２例施行椎手术的６５岁以上的老年患者进行了追踪调查，资料显示：老年患者腰椎手术后，跛行和下肢的术后成绩最佳，而日常生活自理能力和腰痛改善较好，下肢感觉异常等效果欠佳。下肢疼痛病程在５年以内或跛行在１年以人的术后效果良好。     

两种术式治疗中央型腰椎管狭窄症中远期疗效分析

目的 比较经椎板间隙潜行减压椎管成形术与腰椎全椎板减压后外侧融合术治疗腰椎管狭窄症术后中远期临床疗效.方法 2007年4月～2009年2月,收治腰椎管狭窄症患者98例,所有患者术前均有不同程度的间歇性跛行和下肢放射性疼痛.手术前均行腰椎过度屈伸位X线片和MRI检查,均无腰椎不稳和滑脱,结合临床症状明确诊断并确定减压范围...     

体重对腰椎后路开窗减压手术疗效的影响

目的对不同体重老年腰椎管狭窄患者行单纯腰椎后路开窗减压手术,并评价其治疗效果。方法回顾性分析1996年12月～2002年12月间145例因老年腰椎管狭窄而采用单纯腰椎后路开窗减压手术治疗患者的病例资料,结合问卷调查患者对手术的满意程度,比较不同体重患者住院期间及术后症状改善情况,评估手术疗效。结果不同体重患者术后腰腿疼痛明显缓解、日常生活质量改善,患者对手术的满意率达67.59%。而且患者的各种统计数据表明,不同体重组之间差异无显著性意义(P>0.05)。结论体重在一定程度上影响老年腰椎管狭窄患者的手术治疗结果。单纯腰椎后路开窗减压手术,可以达到较为理想的治疗效果。     

退变性腰椎管狭窄减压术后下肢疼痛的恢复规律及影响因素

目的观察退变性腰椎管狭窄（degenerative lumbar spinal stenosis, DLSS）减压术后下肢疼痛的恢复规律,并探索影响疼痛恢复的相关因素。方法回顾性分析2013年1月至2014年12月于我科行腰椎管减压术治疗DLSS的153例患者。记录不同时间（术前、术后第1~7天、术后第1~12个月）患者的下肢疼痛视觉模拟量表（visual analogue scale, VAS）评分,观察其变化规律。选择年龄、性别、术前腰椎稳定性、术前VAS评分、手术节段、减压术式作为可能的影响因素,以有序Logistic回归分析影响术后下肢疼痛缓解的相关因素。结果下肢疼痛在减压术后即开始缓解,虽然在术后第2天出现疼痛反跳,但通过脱水及营养神经治疗,VAS评分在术后第5天恢复到术后第1天水平。术后3个月后疼痛缓解达到最佳,之后不再有明显变化。年龄、性别、术前VAS评分是影响椎管减压术后下肢疼痛改善的相关因素,而病程、手术节段、减压术式及术前腰椎稳定性与下肢疼痛改善无关。结论手术减压治疗DLSS术后下肢疼痛的恢复遵循一定规律,年轻、男性及术前疼痛程度较轻的患者实施腰椎管减压术后,其下肢疼痛恢复更好。     

不典型老年极外侧腰椎间盘突出症合并椎管狭窄症脊柱内镜翻修1例

<正>女性患者,74岁,因“腰部间断疼痛、间歇性跛行1年,加重伴右下肢疼痛1个月”,于2020年8月24日在当地医院骨科住院,主要症状为腰痛伴右小腿前外侧疼痛,2020年8月29日,当地医院按“腰椎椎管狭窄症”“腰椎间盘突出症”诊断在局部麻醉下行经皮椎间孔脊柱内镜手术,术后患者腰痛及右小腿前外侧疼痛明显缓解,但右小腿胫前侧出现剧烈疼痛并进行性加重,严重影响患者睡眠,     

脊柱手术发生氨甲环酸相关型癫痫1例

正患者,女,54岁,2017年3月15日因"右下肢疼痛无力4个月,加重1周"以腰椎内固定术后入院。患者4个月前因"腰椎管狭窄症"于我院行腰椎减压内固定手术治疗,术后右下肢疼痛无力,予脱水消肿、消炎止痛等治疗,症状逐渐减轻。1周前患者活动后自觉右下肢疼痛症状较前加重,伴右下肢无力     

脊柱后入路手术治疗Simmon Ⅱ型腰椎退变性侧凸

目的探讨后路手术治疗Simmon型腰椎退变性侧凸的临床疗效。方法自2008年3月至2010年2月对28例Simmon型腰椎退变性侧凸患者,采用后路椎管减压、矫形、椎弓根螺钉内固定加椎间和/或后外侧植骨融合手术治疗,术后随访3个月～2年,观察其疗效。结果全部患者手术顺利,随访时间平均11个月（3～24个月）。83%的患者疼痛明显减轻,下肢神经性间歇性跛行缓解,随访期间矫正度数无明显丢失。结论充分减压、适当矫形、融合加椎弓根螺钉内固定是治疗Simmon型腰椎退变性侧凸安全有效的方法。     

老年患者下肢骨折手术后的并发症和危险因素

正随着人口老龄化的进展,老年患者下肢骨折的人数日渐增多。由于外科和麻醉技术的进步以及老年患者对生存质量要求的提高,更多的下肢骨折老年患者选择手术治疗。而老年患者往往并存多种疾病,加之此类手术常常创伤大、出血多、术后疼痛严重,因此老年患者行下肢骨折手术,术后常常合并多种并发症且术后死亡率较高。这是包括麻醉科医师在内的围术期相关专业医师不可回避的问题。本文主要对老年下肢骨折术后转归及其危险因素进行综述,为     

退行性腰椎侧凸的手术治疗

目的:探讨手术治疗退行性腰椎侧凸的临床效果。方法:回顾分析自2000年1月～2003年12月收治的24例退行性腰椎侧凸患者的临床资料,2例采用单纯椎管减压术,22例行减压+后路矫形内固定融合术。观察手术前后Cobb角、腰背痛和间歇性跛行的改善率。结果:术后患者的症状和体征均有明显改善,疼痛改善率83.3%,间歇性跛行改善率91.6%。术前Cobb角平均22.7°(17°～42°),术后Cobb角平均8.3°(0°～32°),改善率63.4%;腰椎前凸角术前平均-19.1°(-45°～11°),术后平均-34.4°(-60°～-16.2°),改善率80.1%。随访14～50个月,平均21个月,未见矫正明显丢失,无断钉及螺钉松动。结论:手术治疗退行性腰椎侧凸能够取得比较满意的临床效果和畸形矫正效果。     

经皮椎体后凸成形术治疗老年胸腰椎椎体压缩骨折的疗效观察

目的观察经皮椎体后凸成形术治疗老年胸腰椎椎体压缩骨折的效果。方法比较38例接受手术治疗的患者术前术后的VAS评分,并测量X线侧位片的椎体高度和Cobb’s角度改变,评价手术的安全性和有效性。结果全部病例疼痛完全解除或有明显缓解,术后椎体高度平均恢复32%,Cobb’s角平均矫正24.6°。结论对于胸腰椎椎体压缩骨折的老年患者,选择椎体后凸成形术近期治疗效果好,值得在临床推广。     

棘突旁小切口微创手术治疗老年腰椎间盘突出症

目的 :探索治疗老年性腰椎间盘突出症的理想入路和手术方法。方法 :1994～ 2 0 0 2年采用病变棘突连线旁纵行小切口 ,微创开放手术治疗老年性腰椎间盘突出症 86例 ,术后随访 1～ 6年。结果 :按Macnab疗效评定标准 ,本组病例优 48例 ,良 3 3例 ,可 5例 ,无差病例。结论 :本术式具有手术创伤小 ,出血少 ,显露好 ,操作方便 ,减压充分 ,不影响脊柱的稳定 ,术后并发症少等优点 ,符合外科微创的要求     

Lumbar sympathectomy in the treatment of uncomplicated intermittent claudication.

The precise role lumbar sympathectomy plays in the treatment of uncomplicated intermittent claudication continues to be debated. Past experience at this institution indicates that lumbar sympathectomy has a definite positive role in uncomplicated intermittent claudication. A critical analysis of the 86 patients included in this study adds further support to this contention. Properly selected patients who undergo complete anatomic sympathetic denervation of the lower limbs continue to have very satisfactory results, as they have since 1947 in this institution.     

Assessment of lumbar spinal canal stenosis by magnetic resonance phlebography

 There is evidence to suggest that cauda equina intermittent claudication is caused by local circulatory disturbances in the cauda equina as well as compression of the cauda equina. We evaluated the role of magnetic resonance phlebography (MRP) in identifying circulatory disturbances of the vertebral venous system in patients with lumbar spinal canal stenosis. Extensive filling defects of the anterior internal vertebral venous plexus were evident in patients with lumbar spinal canal stenosis (n = 53), whereas only milder abnormalities were noted in patients with other lumbar diseases (n = 16) and none in normal subjects (n = 13). The extent of the defect on MRP correlated with the time at which intermittent claudication appeared. In patients with lumbar spinal canal stenosis, extensive defects of the internal vertebral venous plexus on MRP were noted in the neutral spine position, but the defect diminished with anterior flexion of the spine. This phenomenon correlated closely with the time at which intermittent claudication appeared. Our results highlight the importance of MRP for assessing the underlying mechanism of cauda equina intermittent claudication in patients with lumbar spinal canal stenosis and suggest that congestive venous ischemia is involved in the development of intermittent claudication in these patients. Received: January 16, 2002 / Accepted: August 5, 2002 Offprint requests to: M. Manaka     

The diagnostic effect from axial loading of the lumbar spine during computed tomography and magnetic resonance imaging in patients with degenerative disorders.

STUDY DESIGN: Patients with low back pain, sciatica, and neurogenic claudication were observed during computed tomographic myelography or magnetic resonance imaging in psoas-relaxed position and axially compressed supine position of the lumbar spine. OBJECTIVE: To estimate the clinical value of axially loaded imaging in patients with degenerative disorders of the lumbar spine. SUMMARY OF BACKGROUND DATA: Computed tomography and magnetic resonance imaging still are performed with the lumbar spine in a supine relaxed position, which results in unloading of the spine and enlargement of the canal. METHODS: A device for axial loading of the lumbar spine in computed tomography and magnetic resonance imaging was used. Altogether, 172 patients were examined in psoas-relaxed position and axially compressed supine position of the lumbar spine: 50 patients with computed tomographic myelography and 122 patients with magnetic resonance imaging. If a significant decrease (>15 mm2) in the dural sac cross-sectional area to values smaller than 75 mm2 (the borderline value for stenosis) was found during examination in axial loading, or if a suspected disc herniation, narrow lateral recess, narrow intervertebral foramen, or intraspinal synovial cyst changed to being obvious at the axial loading examination, this was regarded as additional information important for the treatment. RESULTS: Additional valuable information was found in 50 of 172 patients (29%) during examination in axial loading. In the different diagnostic groups, additional valuable information was found in 69% of the patients with neurogenic claudication, in 14% of the patients with sciatica, and in 0% of the patients with low back pain. The percentage of additional valuable information increased to 50% in the patients with sciatica, if recommended inclusion criteria for examinations in axial loading were used. A narrowing of the lateral recess causing compression of the nerve root was found at 42 levels in 35 patients at axial loading. CONCLUSION: According to the study results, axially loaded imaging adds frequent additional valuable information, as compared with conventional imaging methods, especially in patients with neurogenic claudication, but also in patients with sciatica if defined inclusion criteria are used.     

应用腹腔镜行下腰椎手术的入路选择

目的观察下腰椎各椎间隙节段前方和侧前方毗邻的血管结构,测量各节段手术空间的大小,为应用腹腔镜行下腰椎手术选择合适的入路提供依据。方法解剖15具成人尸体标本（男9例,女6例）,记录下腰椎各椎间隙节段前方和侧前方毗邻的主要血管解剖学参数,并计算出相应的结果。结果 L3～4、L4～5节段前方为腹主动脉及其分支或下腔静脉及其属支,经过分离及牵拉大血管后仍无法满意显露L3～4、L4～5椎间隙;L3～4、L4～5节段左右侧前方各有一无血管神经分布的矩形区域,可以满足腰椎侧前方的手术操作。L5～S1椎间隙位于左髂总静脉与右髂总动脉所形成的＂∧＂形区域内,该区域可以满足手术需要的空间;L5～S1椎间隙侧前方由于大血管的分布和髂嵴的遮挡,不利于手术空间的显露。结论应用腹腔镜行下腰椎手术是可行的,L3～4、L4～5节段经腹膜后途径通过左右侧前方的无血管神经分布的区域可以进行手术的操作;L5～S1椎间隙经腹腔通过椎体前方途径可以满意显露手术空间。     

后路椎间融合术治疗老年腰椎间盘突出症的安全性

目的探讨后路椎间融合术治疗老年椎间盘突出症的方法、应用价值及安全性。方法对89例确诊为老年椎间盘突出症的患者进行开放后路椎间融合术,包括后正中开放入路,扩大开窗、半椎板或全椎板切除,椎管扩大成形,椎弓根螺钉植入,椎间撑开切除椎间盘,刮除终板软骨层,植入经修剪的颗粒骨、大块关节突骨块、椎板骨块,或椎间Cage融合器,椎弓根螺钉系统加压固定。结果所有患者术前均经详尽检查除外绝对手术禁忌,其中约65%曾请相关科室会诊指导围手术期处理。平均手术时间为100min,平均失血量350mL。所有病例均经术后随访,随访时间为12～24个月,原有的神经压迫症状基本恢复,无间隙性跛行,下腰痛较术前明显缓解,患者满意率91%。椎间高度术前3.4～7.8mm,平均高度5.1mm,术后3个月椎间高度9.6～12.4mm,平均11.2mm。在12个月随访时平均高度为9.0～12.1mm,平均为10.8mm。12个月椎间融合率91.0%。主要并发症为:10例患者出现神经根刺激症状,4例患者出现脑脊液漏,均缓解,无一例出现严重感染或危重并发症。结论应用后路椎体间融合技术结合椎弓根钉棒固定技术治疗老年腰椎间盘突出症能够充分减压,恢复并维持椎间隙高度,重建腰椎稳定性,并具备手术安全性。     

老年性腰椎间盘突出症诊断和治疗特点——附56例临床报告

目的 研究老年性腰椎间盘突出症的临床表现和治疗的特点。方法 回顾分析近10年来经手术治疗,资料完整的56例老年性腰椎间盘突出症。结果 在随访平均4年的48例中,优良率为85．4％(41,48)。结论 老年性腰椎间盘突出症病史长,症状不典型,cT能明确诊断。在控制合并症的基础上选择适当的麻醉,行半椎板切除、全椎板切除椎管扩大髓核除手术,疗效多获满意。     

椎管减压、内固定联合Cage椎间融合与横突间植骨融合治疗退行性腰椎滑脱的比较

目的 比较腰椎管减压、椎弓根内固定联合后路Cage椎间融合与横突间植骨融合治疗退变性腰椎滑脱合并腰椎管狭窄的早期临床疗效。方法 分别采用椎管减压、椎弓根内固定联合后路Cage椎间融合与横突间植骨融合治疗经严格保守治疗无效的退行性腰椎滑脱患者31例和19例。比较术后临床症状改善和滑脱复位情况。结果 随访时两组患者腰骶部疼痛改善率分别为80％和84．2％，间歇性跛行改善率分别为88．46％和85．7％。I度滑脱完全复位分别为26例和14例，Ⅱ度滑脱完全复位分别为3例和2例，总复位率分别为93．5％和84．2％。所有病例椎间高度恢复正常或接近正常，Cage位置良好，无脱出，未见下沉。椎弓根内固定器无脱出、弯曲和断裂。结论 椎间融合与横突间植骨融合治疗退行性腰椎滑脱都能达到满意复位，可以充分减压，重建脊柱生理序列和稳定性，在复位率、症状改善率、手术后并发症方面均无显著性差异，临床效果满意。     

应用FRAX联合腰椎或股骨颈骨密度评估中老年女性骨折风险的临床研究

目的探讨应用FRAX联合腰椎或股骨颈骨密度评估中老年女性骨折风险。方法选取2017年3月至2018年6月在连云港市第一人民医院行骨密度检查的女性337例,收集其个人基本信息、FRAX风险评估值及腰椎和股骨颈骨密度,按照骨密度及年龄分组,根据上述资料计算10年内主要部位骨质疏松性骨折概率和10年内髋部骨折概率,比较FRAX联合腰椎或股骨颈骨密度评估骨折风险的差异。结果无论代入股骨颈骨密度还是腰椎骨密度计算骨折风险,骨质疏松组的骨折风险均高于骨量减少组(P0.05);②无论是在骨质疏松组还是在骨量减少组,采用股骨颈骨密度计算的骨折风险均高于采用腰椎骨密度计算的值(P0.05)。③进一步分析显示,不同年龄组采用股骨颈骨密度计算出的骨折风险均高于采用腰椎骨密度计算的值(P0.05)。结论对于不同年龄组的骨量异常女性,FRAX联合股骨颈骨密度预测的骨折风险高于联合腰椎骨密度预测的骨折风险。     

Results of surgery for spinal stenosis adjacent to previous lumbar fusion

The literature provides little data to guide surgical management of spinal stenosis adjacent to previous lumbar fusion. Thirty-three consecutive patients who had surgical decompression for spinal stenosis at the lumbar segments adjacent to a previous lumbar fusion were studied. The mean interval between fusion and the adjacent segment surgery was 94 months. Of the 33 patients, 26 were followed for 3-14 years (mean: 5 years) after adjacent segment surgery and were clinically evaluated and independently completed an outcome questionnaire. Of the 26 patients, 15 rated their outcome as completely satisfactory, 6 were neutral toward the surgery, and 5 considered their surgery a failure. The surgery was generally effective at improving or relieving lower extremity neurogenic claudication. The strongest independent predictive factor of patient dissatisfaction was ongoing postoperative low back pain (r = 0.7, p = 0.001). A higher back pain score at follow-up was associated with continued narcotic use (p = 0.001) and decreased ability to perform activities of daily living (p = 0.05). Six patients required further lumbar surgery during the follow-up period. This study provides the longest published follow-up data of surgical results for symptomatic spinal stenosis adjacent to a previously asymptomatic lumbar fusion.