Occipitocervicothoracic fixation using a hook and rod system for patients with rheumatoid cervical spine

We retrospectively examined the outcomes of occipitocervicothoracic fixation using a hook and rod system for rheumatoid patients with cervical myelopathy in which decompression of the spinal cord and spinal fusion were performed simultaneously at multiple levels. There were 10 female patients with rheumatoid arthritis (ages 51–77 years, average 62.8 years; follow-up period 6 months to 3 years and 9 months, average 2 years and 8 months). Atlantoaxial subluxation was found in 5 patients, vertical subluxation in 4 patients, and subaxial subluxation in 8 patients. The progression of the disorder was assessed as class 4 stage 4 in 3 patients and class 3 stage 4 in 7 patients. The average time taken for surgery was 4 h 41 min, and the average volume of blood loss was 729 ml. There were no complications during surgery. One patient died of malignant lymphoma 1 month after surgery, and one patient died of heart failure 2 years and 3 months after surgery. The average Japanese Orthopaedic Association (JOA) score improved from 7.0 preoperatively to 9.5 postoperatively. Preoperative nuchal pain in 3 patients and difficulty in breathing on flexion of the cervical spine in 2 patients were improved after surgery. Good bony union was obtained in 9 patients. The exception being one patient who died of a disease unrelated to the surgery 1 month postoperatively. Occipitocervicothoracic fixation using a hook and rod system is an easy and safe procedure, and can facilitate not only good bony union, but also adequate decompression of the spinal cord with simultaneous laminoplasty because of the secure long fixation extending to the upper thoracic level and bilateral grafting of a considerable volume of bone.     

The surgical treatment of destructive forms of tuberculosis of the cervical spine

The paper analyzes the outcomes of surgical treatment in 19 patients with tuberculosis of the cervical part of the vertebral column. All the patients had surgical treatment: abscessotomy, sparing resection of a destruction area, decompression of the spinal cord, removal of kyphotic deformity by restoring the axis of the vertebral column. The existing defect was filled with an autograft in 7 cases, with a biocompatible implant by applying benemycin to its surface in 12 cases. Posterior fixation of the diseases part of the spinal apparatus was made in 8 cases. Good outcomes were followed up 8 months to 7 years after surgery. At X-ray study, the bony block formed between the resected vertebral bodies within 3 to 7 months. Neurological symptoms were arrested in all cases, except 4 ones. One patient was found to have a slight lower extremity weakness and 3 patients had correctable radicular symptoms.     

一期前路病灶清除植骨内固定治疗胸腰椎结核的疗效

目的 总结一期前路病灶清除植骨内固定治疗胸腰椎结核的临床效果.方法 自2001年1月至2006年2月采用一期前路病灶清除、椎间自体髂骨或钛笼植入、前路或后路内固定治疗胸、腰椎结核68例,男39例,女29例.年龄28～76岁,平均36.8岁.病程3个月至1.5年,平均8个月.随访观察植骨融合、脊柱后凸畸形的矫正效果以及神经功能恢复情况.结果 随访1.5至5年,平均36个月.3例患者术后出现窦道,经换药后伤口均愈合.术后平均3.2个月ESR下降到正常.28例不全性截瘫患者中,27例于术后24 h至3个月感觉、肌力及括约肌功能逐渐恢复,末次随访时美国脊髓损伤协会(ASIA)分级提高;仅1例术后神经功能无明显改善,末次随访时ASIA分级无变化.植骨均获骨性融合,愈合时间3～15个月,平均4.8个月.内固定物无松动、脱出及断裂.术前平均脊柱后凸度数Cobb角为41.2°,术后1周平均Cobb角为13.6°,平均矫正27.6°;末次随访平均Cobb角为15.8°,平均丢失2.2°.无脊柱结核复发.结论 一期前路病灶清除植骨内固定治疗胸腰椎结核可以获得满意的临床效果.     

脊柱结核合并截瘫再手术分析（附32例报告）

目的探讨脊柱结核合并截瘫手术失败的原因及再次手术方法。方法回顾性分析1993-2004年收治的手术治疗失败的脊柱结核合并截瘫病例，其中男18例，女14例；颈胸椎3例，胸椎19例，胸腰椎10例。累及椎体数1-8个，平均4．5个；第一次术前抗结核药物治疗时间0-9个月不等；由前路开胸减压手术17例。肋骨横突切除侧后方减压15例：术后22例给予抗结核治疗。其中术后16例病人截瘫有所改善（短期改善9例，3个月改善3例，6个月改善4例）。17例截瘫没有改善；2例损伤脊髓截瘫加重；另术后合并瘘管形成6例，继发肺结核1例，结核性脑膜炎1例，脊髓本身结核1例。全身结核瘫状明显伴有高热4例。结果23例选择前路开胸病清减压手术。同时给予植骨，其中9侧行钛板内固定：5例行侧后方经胸廓胸膜外减压术，2例行单纯瘘管搔刮病灶清除术，术后继续抗结核治疗。其中22倒截瘫完全恢复，6例部分恢复；另脊柱结核完全治愈。结论脊柱结核合并截瘫治疗失败的原因为：抗结核治疗不合理；合并它处结核：多椎体结核；手术时机、手术方式选择不合理；手术减压范围不够以及脊髓神经结核和脊髓受压变性等情况。成功的关键是：在有效的抗结核化疗基础上，严格掌握手术适应证，选择合理的手术时机和手术途径，彻底地减除病灶对脊髓的压迫。重建脊柱的稳定性。     

单侧开门外侧块螺钉固定植骨治疗颈脊髓压迫症

目的 探讨单侧开门外侧块螺钉固定植骨术治疗颈脊髓压迫症的临床疗效.方法 自2004-02～2008-06采用单侧开门外侧块螺钉固定植骨术治疗颈脊髓压迫症26例,男18例,女8例;年龄51～67岁,平均58岁.26例中有22例为多节段脊髓型颈椎病(3个或3个节段以上),其中10例合并发育性椎管狭窄症(6例合并动力性椎管狭窄症,3例合并后纵韧带骨化症,1例为外伤性);4例为颈椎管内肿瘤.随访9个月～2年2个月,平均1年8个月.结果 疗效评定标准参照日本整形外科协会(JOA)评分标准,优8例,良15例,可2例,差1例,优良率为88.5%.无一例出现血管损伤或内固定物断裂并发症,1例脊膜瘤因肿物过大术后出现脊髓再灌注损伤表现,经积极治疗好转,生活可自理.结论 该法适用于需要从后方入路进行减压的颈脊髓压迫症,疗效肯定.其优点是手术相对安全,在彻底减压的同时进行坚强的内固定,尤其适用于伴有节段性不稳的脊髓型颈椎病.     

一期前路病灶清除并钛笼肋骨植骨加钉棒系统内固定治疗胸椎结核(附21例报告)

目的 分析一期前路病灶清除并钛笼肋骨植骨加钉棒系统内固定治疗胸椎结核的临床效果。方法 2009年9月至2016年12月采用一期前路病灶清除并钛笼肋骨植骨加钉棒系统内固定术治疗胸椎结核28例,获得随访21例,男14例,女7例,其中胸5、6椎体结核1例,胸6、7椎体结核3例,胸7、8椎体结核3例,胸9、10椎体结核 2例,胸10、11椎体结核4例,胸11、12椎体结核2例;胸6、7、8椎体结核1例,胸7、8、9椎体结核3例,胸9、10、11椎体结核2例;根据术前、术后随访的Frankel脊髓损伤分级、视觉模拟评分法(VAS)评分结果,以及脊柱后凸Cobb角矫正和植骨融合情况评价临床治疗效果。结果 随访10个月至7年,Frankel分级,术前B级1例,C级5例,D级6例,E级9例;末次随访时D级4例,E级17例。VAS评分术前平均为(6.29±1.27)分,术后1周平均为(2.81±0.87)分,末次随访时平均为(1.24±0.89)分。术前测量患者的Cobb角平均为(19.81±11.08)°,术后1周平均为(3.81±2.77)°,末次随访时平均为(4.52±3.23)°;21例患者均获骨性融合,融合时间5~11个月,平均(6.93±1.33)个月,至末次随访未发现内固定钉棒系统松动、脱落及断裂。结论 一期前路病灶清除并钛笼肋骨植骨加钉棒系统内固定术治疗胸椎结核,能有效清除病灶,解除神经压迫,矫正后凸畸形,重建脊柱稳定性,可获得良好的临床效果。     

Cutaneous sensory impairment in rheumatoid atlanto-axial subluxation assessed quantitatively by electrical stimulation

Thresholds for cutaneous perception and pain in 27 rheumatoid patients were investigated by electrical stimulation. Patients with atlanto-axial subluxation showed impaired sensibility over the ophthalmic division of the trigeminal nerve. Patients with vertical atlanto-axial subluxation showed in addition to a pronounced decrease in the sensibility over the ophthalmic and maxillary divisions of the trigeminal nerve, also sensory disturbances over cervical, thoracic and lumbar levels. The mandibular division was never affected. The trigeminal sensibility seems to be affected early in the rheumatoid atlanto-axial subluxation and progresses with the severity of the subluxation, possibly due to bony compression of the trigeminal spinal tract at C 1 level.     

Wallis棘突间动态内固定治疗老年节段性腰椎管狭窄的短期临床效果

目的 探讨后路椎管减压和Wallis棘突间动态内固定治疗老年节段性腰椎管狭窄症的术后短期临床效果。方法回顾性分析2008年1月至2010年12月在解放军空军总医院行后路椎管减压、Wallis棘突间动态内固定治疗的25例腰4．5节段椎管狭窄症的老年患者。男11例,女14例;平均年龄65岁。所有患者随访期均≥6个月。记录所有患者术前、术后3天、术后1个月、术后6个月Oswestry功能障碍指数（ODI）评分及视觉模拟评分（VAS）评分,测量手术节段（腰4-5）和邻近节段（腰3-4、腰 5-骶1）椎间隙与椎间孔高度。记录所有患者术中、术后并发症。结果25例患者均在椎管减压后顺利置人Wallis系统。术中、术后未发生手术相关并发症。所有患者术后临床症状均有缓解,术后3天、1个月、6个月时ODI评分和VAS评分与术前比较,差异均有统计学意义（P〈0．01）。术后1个月、6个月邻近节段（腰3-4、腰 5-骶1）椎间隙与椎间孔高度与术后3天比较,差异均无统计学意义（P〉0．05）。结论椎管减压和Wallis棘突间动态内固定治疗老年节段性腰椎管狭窄症的术后短期随访临床效果满意,Wallis系统可有效维持手术节段椎间隙及椎间孔高度,短期随访未发现引起邻近节段明显退变。     

Cervical spine involvement early in the course of rheumatoid arthritis

Objectives

Cervical spine involvement in rheumatoid arthritis (RA) is considered a feature of long-standing disease. We describe two patients who presented with cervical symptoms as early features of RA.

Methods

We report two RA cases with cervical spine involvement as early features and use MEDLINE to review the literature concerning the frequency and disease duration of this manifestation and its imaging with plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI).

Results

An 80-year-old man with cervical myelopathy from a C1–C2 rheumatoid pannus underwent decompression surgery before development of peripheral synovitis from RA. A 63-year-old woman presented with neck pain and polyarthritis at RA diagnosis, with imaging that confirmed a C1–C2 rheumatoid pannus. Onset of cervical spine involvement in RA is generally after 10 years of disease duration, ranging from 3 months to 45 years after peripheral synovitis among patients with seropositive erosive RA. Occurring in 9–88% of RA patients, cervical spine involvement may result in cervical instability due to either mechanical compression or vascular impairment of the spinal cord. Bone erosions and atlanto-axial subluxation on standard radiographs are two major signs of cervical spine involvement in RA. MRI identifies earlier signs of RA and has a higher sensitivity in detecting bone erosions compared to conventional radiography.

Conclusions

Cervical spine involvement in RA is not an uncommon condition but is rare at early disease onset. Symptoms of cervical pain and myelopathy should prompt a thorough neurological examination accompanied by imaging.     

前路手术在胸腰椎结核治疗中的优势

目的总结前路一期病灶清除、硬膜前方减压、一期后凸畸形矫正、植骨及内固定重建脊柱稳定治疗胸腰椎结核的临床疗效。方法回顾性分析我院2007年1月~2015年1月通过一期前路手术病灶清除、硬膜前方减压、一期后凸畸形矫正、植骨及内固定重建脊柱稳定治疗的胸腰椎结核32例的临床资料。统计植骨融合时间及手术前后血沉(ESR)、C-反应蛋白(CRP)、后凸畸形角度(Cobb角)和ASIA分级的变化。结果手术时间为(177.3±14 5)min,术中出血量为(492.5±170.1)ml。随访18~72(36.9±12.7)个月,所有患者脊柱结核治愈无复发。植骨融合时间3~8(5.5±1.1)个月。血沉及C-反应蛋白在术后3个月基本恢复正常,末次随访时ASIA分级均恢复正常。脊柱后凸畸形角度由术前(17.6°±6.4°)减小至术后的(2.5°±1.3°),末次随访为(3.8°±1.5°),没有显著的矫正角度的丢失(1.3°±0.6°),其中术后、末次随访较术前明显改善,差异有统计学意义(P0.05)。在末次随访时,所有患者的植骨融合良好,无内固定松动及断裂。结论前路手术在胸腰椎结核中可以达到一期病灶清除、硬膜前方减压、一期后凸畸形矫正、植骨及内固定并重建脊柱稳定性的目的,临床疗效满意。     

Usefulness of preoperative Short Form-36 Mental Component Score as a prognostic factor in patients who underwent decompression surgery for degenerative lumbar spinal stenosis

Physical factors such as frequency of low back pain, sensory abnormalities in the lower extremities, smoking history before surgery, and preoperative mental health status as predictors of operative outcomes have been growing as areas of interest in the field of degenerative lumbar spinal stenosis (DLSS). This study aimed to investigate the correlation between the preoperative Short Form-36 Mental Component Score (SF-36 MCS) and long-term prognosis after decompression surgery for DLSS. In total, 198 patients were enrolled in this study. The Oswestry Disability Index (ODI) and Rolland Morris Disability Questionnaire (RMDQ) were used to evaluate spinal functional outcomes. The SF-36 questionnaire was used and analyzed by classifying it into physical component score (PCS) and mental component score (MCS). The SF-36 MCS was divided into role limitations caused by emotional problems, social functioning, vitality, and emotional well-being. In the correlation between preoperative MCS and ODI improvement, the r value was −0.595 (P < .05) at 12 months postoperatively. ODI improvement at 12 months after decompression surgery showed a statistically significant and strong negative correlation with preoperative MCS. In the correlation between preoperative MCS and RMDQ improvement, the r value was −0.544 (P < .05) at 12 months postoperatively. Therefore, RMDQ improvement 12 months after decompression surgery showed a strong negative correlation with preoperative MCS. Regarding the correlation between preoperative MCS and SF-36 PCS improvement, the r values were 0.321 (P < .05) at 6 months postoperatively and 0.343 (P < .05) at 12 months postoperatively. Therefore, SF-36 PCS improvement at 6 and 12 months after decompression surgery showed a strong positive correlation with preoperative SF-36 MCS scores. Preoperative SF-36 MCS is a factor that can predict the prognosis of patients who underwent decompression surgery for lumbar spinal stenosis for at least 1 year postoperatively.     

Cervical spine involvement early in the course of rheumatoid arthritis

ObjectivesCervical spine involvement in rheumatoid arthritis (RA) is considered a feature of long-standing disease. We describe two patients who presented with cervical symptoms as early features of RA.MethodsWe report two RA cases with cervical spine involvement as early features and use MEDLINE to review the literature concerning the frequency and disease duration of this manifestation and its imaging with plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI).ResultsAn 80-year-old man with cervical myelopathy from a C1–C2 rheumatoid pannus underwent decompression surgery before development of peripheral synovitis from RA. A 63-year-old woman presented with neck pain and polyarthritis at RA diagnosis, with imaging that confirmed a C1–C2 rheumatoid pannus. Onset of cervical spine involvement in RA is generally after 10 years of disease duration, ranging from 3 months to 45 years after peripheral synovitis among patients with seropositive erosive RA. Occurring in 9–88% of RA patients, cervical spine involvement may result in cervical instability due to either mechanical compression or vascular impairment of the spinal cord. Bone erosions and atlanto-axial subluxation on standard radiographs are two major signs of cervical spine involvement in RA. MRI identifies earlier signs of RA and has a higher sensitivity in detecting bone erosions compared to conventional radiography.ConclusionsCervical spine involvement in RA is not an uncommon condition but is rare at early disease onset. Symptoms of cervical pain and myelopathy should prompt a thorough neurological examination accompanied by imaging.     

Surgical treatment of cervical cord compression in rheumatoid arthritis.

Cervical myelopathy is a rare but potentially dangerous complication of rheumatoid arthritis and presents considerable therapeutic problems. A conservative approach carries high mortality and surgical intervention is not without serious risks. Reduction of subluxation and posterior fusion is widely practised but may require prolonged bed rest and continuous skull traction, sometimes for many weeks. When anterior decompression has been attempted prolonged immobilisation and external fixation have created problems. In this series 23 rheumatoid patients with cervical myelopathy were investigated over a four-year period. Seventeen underwent anterior decompression of the cervical cord, of whom 14 had a transoral removal of the odontoid peg and pannus and posterior occipitocervical fusion during the same anaesthetic without mortality or serious postoperative complications; all but one have improved. The authors believe that early mobilisation after a combined cord decompression and internal fixation has reduced the mortality and morbidity. Management of cervical myelopathy in rheumatoid arthritis and indications for operation are discussed.     

High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery

OBJECTIVE: To study the prevalence of cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery, and symptoms that might be associated with the disorders. METHODS: 194 patients with rheumatoid arthritis were referred for orthopaedic surgery at Jyv?skyl? Central Hospital, 154 (79%) of whom volunteered for the present study including clinical examination, laboratory tests, radiographs of the cervical spine, hands, and feet, and self report questionnaires. Definition of anterior atlantoaxial subluxation (aAAS) was >3 mm and of subaxial subluxation (SAS)>or=3 mm. Atlantoaxial impaction (AAI) was analysed following to the Sakaguchi-Kauppi method. RESULTS: 67 patients (44%) had cervical spine subluxation or previous surgical fusion. The prevalence of aAAS, AAI, SAS, or previous fusion was 27 (18%), 24 (16%), 29 (19%), and 8 (5%), respectively; 69% of patients with cervical spine subluxations (those with fusions excluded) reported neck pain, compared with 65% of patients without subluxations (p=0.71). The prevalence of occipital, temporal, retro-orbital, and radicular pain in upper extremities was similar in patients with or without cervical spine subluxations (54% v 43%; 17% v 31%; 25% v 24%; 47% v 48%, respectively). However, patients with subluxations were older, had longer disease duration, more active disease, poorer function according to the Health Assessment Questionnaire, and had more often erosive disease. CONCLUSIONS: Asymptomatic cervical spine subluxation is common in patients with rheumatoid arthritis waiting for orthopaedic surgery. Regardless of symptoms, the possibility of cervical spine subluxation in patients with severe rheumatoid arthritis should be considered in preoperative evaluation.     

经口咽入路显微外科治疗颅颈区畸形

目的：探讨颅颈区畸形经口咽入路显微直视减压手术的方法和疗效。方法：本组58例颅颈区畸形患者，以颅底陷入为主的枕骨大孔区先天畸形42例(16例伴有颅后窝容积减小、小脑扁桃体下疝及脊髓空洞症)．慢性环枢椎脱位11例．齿状突骨折及脱位5例。采用经口咽入路显微镜直视下切除齿状突、斜坡下部及增生结缔组织，解除其对延髓、颈髓的压迫；围手术期行气管切开、颅骨牵引、植骨固定等。结果：术后随访O．5～7年，症状明显好转47例，减轻7例，无效3例，死亡1例。结论：采用显微外科技术经口咽入路治疗颅颈区畸形，可降低术后并发症和致残率；重视围手术期处理可预防术后伤口感染和脑脊液漏；二期植骨能增加颈椎稳定性。     

Clinical characteristics affecting survival in patients with rheumatoid arthritis undergoing cervical spine surgery: a controlled study

A controlled study of the clinical characteristics affecting survival in patients with rheumatoid arthritis (RA) with cervical spine involvement treated surgically demonstrated a strong association between disease severity, the frequency of severe extraarticular manifestations, especially interstitial lung disease, and a decreased probability of survival. These probabilities at 1 and 5 years postoperatively were 74 and 54%, respectively. Death resulted most often from infection or comorbid conditions. All surgery patients with interstitial lung disease died within 28 months postoperatively. In patients with RA undergoing cervical spine surgery, fatality rates appear to be increased in patients with severe extraarticular manifestations, especially interstitial lung disease.     

Anterolateral Radical Debridement and Interbody Bone Grafting Combined With Transpedicle Fixation in the Treatment of Thoracolumbar Spinal Tuberculosis

This retrospective cohort study was conducted to evaluate the clinical outcomes of radical anterolateral debridement and autogenous ilium with rib or titanium cage interbody autografting with transpedicle fixation for the treatment of thoracolumbar tuberculosis.Spinal tuberculosis operation aims to remove the lesions and necrotic tissues, remove spinal cord compression, and reconstruct spinal stability. However, traditional operation methods cannot effectively correct cyrtosis or stabilize the spine. In addition, the patient needs to stay in bed for a long time and may have many complications. So far, the best surgical method and fixation method for spinal tuberculosis remain controversial.There were a total of 43 patients, 16 involving spinal cord injury, from January 2004 to January 2011. The patients were surgically treated for radical anterolateral debridement via posterolateral incision and autogenous ilium with rib or titanium cage interbody autografting and single-stage transpedicle fixation. All the patients were followed up to determine the stages of intervertebral bone fusion and the corrections of spinal kyphosis with the restoration of neurological deficit.The erythrocyte sedimentation rate (ESR) of these patients decreased to normal levels for a mean of 2.8 months. The function of feeling, motion, and sphincter in 16 paraplegia cases gradually recovered after 1 week to 3 months postoperatively, and the American Spinal Injury Association scores significantly increased at the final follow-up. Intervertebral bone fusions were all achieved postoperatively. No internal fixation devices were loose, extracted, or broken. There was no correction degree loss during the follow-up.The method of radical anterolateral debridement and autogenous ilium with rib or titanium cage interbody autografting and single-stage transpedicle fixation was effective for the treatment of thoracolumbar tuberculosis, correcting kyphotic deformity, and reconstructing spinal stability, obtaining successful intervertebral bony fusion and promoting the recovery of paraplegia. These results showed satisfactory clinical outcomes.     

A prospective study of the radiological changes in the cervical spine in early rheumatoid disease.

The cervical spine radiographs of 100 patients with early rheumatoid disease were studied annually, on a prospective basis, for a mean follow-up period of 7 years 2 months. Atlantoaxial subluxation developed in 12 patients. The subluxation was more frequent in females, more severe in patients with progressive, seropositive, erosive rheumatoid disease, and more marked in patients treated with oral corticosteroids. Subaxial subluxation, affecting upper cervical disc levels, occurred in a further 20 patients. Three patients developed vertical subluxation. The mobility of the cervical spine affects the degree of subluxation achieved, and when assessing serial films for subluxation it may be necessary to measure the cervical spine flexion before deciding whether subluxation has progressed or not. Over 80% of the patients with subluxation developed the first evidence of subluxation within 2 years of disease onset. Subluxation in the cervical spine is not, therefore, a late complication of rheumatoid disease. During the follow-up period none of the patients developed neurological signs.     

Amyloidosis associated with rheumatoid arthritis after total joint replacement]

Rheumatoid arthritis patients who had secondary amyloidosis have been studied retrospectively. There were eight patients out of 105 rheumatoid arthritis patients who had total joint replacement surgery from 1979 to 1990 in our institute. The grade of inflammation, renal and hepatic function have been compared with the RA patients without amyloidosis pre- and post- operatively. All of eight patients was female, and their average age at the diagnosis of amyloidosis was 57.8 year-old (range 4-76 year-old). The average preoperative period was 14.4 years (range 4-27 years), and the secondary amyloidosis had been diagnosed at the time of 3.8 years (range 1-9 years) after operation. The major clinical features leading to the diagnosis were gastrointestinal disturbance in six cases and renal dysfunction in two cases. The data of the renal function of amyloidosis patients showed slightly lower than that of the RA patients without amyloidosis, and showed significantly decrease postoperatively. The white blood cell (WBC) count was higher at the time of operation in the amyloidosis patients and showed continuous increase postoperatively. Lansbury index, alpha 2-globulin and WBC count did not improve in the amyloidosis patients during three years after operation. On the contrary, the patients without amyloidosis improved in these clinical data during the same period. Three amyloidosis patients died of renal failure and one died of bronchopneumonia. The average survival period was 1.8 years (range 1-5 years) after diagnosis of amyloidosis, and was 6.3 years (range 2-10 years) after operation in these four patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

经皮椎间孔镜在治疗中老年腰椎间盘突出症中的应用

目的评价应用经皮椎间孔镜(PTED)治疗中老年腰椎间盘突出症的临床效果和价值。方法前瞻性研究分析2016年3月至2018年9月空军特色医学中心骨科采用PTED切除突出椎间盘髓核减压治疗的50～72岁腰椎间盘突出症患者,共50例,并以同期常规开放椎板开窗或半椎板切除减压突出椎间盘髓核切除手术的50～71岁患者50例为对照组。比较2组患者术中出血量、手术时间、术后住院时间。以术后1 d、1个月、3个月疼痛视觉模拟评分(VAS)和术后3个月Oswestry功能障碍指数(ODI),及术后6个月改良MacNab标准评定手术疗效。手术前及术后3～6个月行MRI检查,观察手术前后椎管及椎间盘突出的变化。使用STATA 12.0统计软件进行统计分析。结果 2组患者年龄、术前VAS和ODI评分差异无统计学意义(P0.05),术后VAS和ODI评分较术前均显著下降(P0.01);PTED组术后1 d、1个月的VAS评分显著低于对照组(P0.01)。术后3个月,2组VAS和ODI评分差异无统计学意义(P0.05);术后6个月,2组改良MacNab标准评定功能差异无统计学意义(P0.05);PTED组术中出血量、术后住院时间显著少于对照组(P0.01);2组手术时间无统计学差异(P0.05)。MRI检查结果显示,与术前比较,2组术后3～6个月椎间盘突出均消失或明显减小,椎管通畅、面积明显增大。结论 PTED技术治疗中老年腰椎间盘突出症,中期疗效与单纯开放手术相当,但PTED早期疗效好、损伤小、恢复快、并发症少。